They say the eyes have it. As I’ve gotten older, I’ve realized that “it” is my age. Every single year. Perhaps it’s because I have big eyes, but I feel like one night of crummy sleep can age me five years…or more. There’s the redness, the eyelid crepiness and–probably the most universal sign of raggedness–pitch black under eye circles. What to do, what to do?

I sat down with New York City plastic surgeon and Travel Beauty expert, Dara Liotta MD, to discuss how the face–specifically the under eye/cheek area–age, and what non-surgical options exist to make this aging process a bit more graceful.

“It’s not just wrinkles that age you”

Dr. Liotta said. “If you just ‘chase the lines’, you’ll end up with that obvious, overdone filler look. What can really age the face is volume loss and gravity, leading to a hollowed-out look. If you really want to look more youthful, you have to replace that lost volume.”  I asked Dara how volume loss ages the eye area, and she handed me a mirror. She instructed me to hold the mirror above my head and look up into it. “There are different components to under eye area aging, two are shadow and pigment. When you look up at yourself in a mirror, any shadow disappears, and all you are left with is pigment. No matter what anyone says, there is nothing you can do about pigment. No lasers, fillers or anything else will get rid of it.” (I frown slightly at this because, even looking straight up into the mirror, there is still some darkness underneath my eyes.)

“What you can treat with filler, however, is shadow”

I have some shadow too, so hearing this makes me happy. And hopeful. “Hollowness here [she points to under eye area] creates shadow, and a line right to the eye that draws attention and ages you.” Dr. Liotta said.

To reduce shadow in the under eye area, filler is added to the “tear trough”. This plumps up an otherwise hollowed-out under eye area that can become dark and thus, age us. “I only use Belotero for tear trough injections. It is the thinnest hyaluronic acid filler, which is so important as the skin under the eye is itself so thin. Other, thicker fillers can cause unpredictable swelling.” Indeed, search RealSelf.com for “tear trough reviews”, and you’ll read/see several horror stories of major, unsightly swelling as a result of thicker filler being used to treat tear trough hollowness. [This expertise is why I love Dr. L.]

What about this line that’s starting to form right through my cheeks?

I ask. This line, when coupled with pronounced nasolabial folds (the lines that form from the sides of the nose to the sides of the mouth), is what Dara refers to as the “thumbprint”, because the area between the two “lines” is the exact size of a thumb. She demonstrates by placing her own thumb between the non-existent “line” in her cheek and her non-existent nasolabial folds, but I get the idea.

“Well-done injectable cheek augmentation can take years off of your appearance. Since the skin is thicker in this area, I use Voluma here.” Dr. Liotta said. For those that aren’t on top of their injectable filler game, Juvederm Voluma is another injectable hyaluronic acid gel. It is the first and only FDA-approved filler that can instantly add volume to the cheek area. AND…since Voluma is a thicker filler, the results last two years! The amount of Voluma required for cheek augmentation varies between 1-4 syringes. “As we age, we tend to lose that youthful volume in the cheek area. Then, as gravity causes the natural fat pad of the cheek to drop, the nasolabial folds become more pronounced. By using Voluma to add volume back into the cheek area, you get a subtle, natural lift in the cheek that helps restore a well-rested, youthful look. This lift also improves the appearance of the nasolabial folds.”

Looking at Dr. Liotta’s before and after pics, it was amazing to see how much Voluma injected into cheeks improved the appearance of nasolabial folds–a different area of the face. The improvement is seen in the reduction of “shadow” on the side of the nose…the same reason women spend millions of dollars every year on highlighters meant to mask/minimize/erase such shadows.

I’m not ready to take the Voluma plunge yet

Dara swore I don’t need it yet–but it just might be my 40th birthday gift to myself!

I cannot recommend Dr. Liotta highly enough. As a Board Certified ENT surgeon, as well as a Facial Plastic and Reconstructive surgeon, she is intimately acquainted with, and comfortable manipulating, the complex anatomy of the face. That’s why I won’t trust my face to anyone else. To get more information and to schedule a consultation, visit Dara’s website.

By: Claire McCormack, Twitter & Instagram

The “face” of the plastic surgery conversation is changing. Slowly, cosmetic surgery discussions are becoming more frank, and the details of Botox, filler, and cosmetic surgery – which used to be the secret of the Manhattan and Los Angeles elite – are becoming less secret. In his recent TIME Magazine article entitled, “Nip. Tuck. Or Else.”, Joel Stein comments that, “cosmetic surgery has become the new makeup”.  While I think this is a bit of an overstatement, there is a kernel of truth in it. Little tweaks of Botox and filler, even rhinoplasty, and facelift surgery, are becoming more talked about, thus losing their stigma. Celebrities and civilians alike are speaking more openly about the procedures they’ve had done. We can thank Betty Ford (facelift and blepharoplasty), Joan Rivers (lots!), Ashlee Simpson (rhinoplasty), Renee Zelwiger (blepharoplasty), and most recently, Caitlyn Jenner (facial feminization and breast implants) for speaking frankly about cosmetic surgery.  We can thank sites like RealSelf for helping demystify the logistics of cosmetic procedures, as well as helping people become more educated cosmetic consumers.

Have No Doubt:

Cosmetic surgery is happening all around you. According to the International Society of Aesthetic Plastic Surgery (ISAPS), more than 20 million cosmetic surgical and nonsurgical procedures were performed worldwide in 2014, with the United States ranking number one for most cosmetic surgical and non-surgical procedures performed in 2014 (Brazil was briefly number one in 2013, but Brazilian Butt Lift be damned, we managed to regain the number one spot this past year). Cosmetic surgery technology is advancing, and procedures are becoming more minimally-invasive, with short, or no, recovery time required. As the technology advances, procedures become more common, and the cost is coming down, making procedures affordable to more people. Surgeons are also becoming more skilled, and more subtle, making results more predictable and less scary.

Along The Beauty Continuum

More and more in my practice, I see cosmetic procedures, particularly Botox and filler, regarded as regular maintenance rather than narcissistic indulgences. I even have many patients that come in for treatments with friends and make a day of it. I’ve seen that, with time, the idea of beauty and personal upkeep is becoming a continuum, with haircuts and shopping on one end and facelifts on the other. There are no longer any hard stops. If you have no reservations about coloring your hair with chemical dyes when it turns gray, why shouldn’t you take advantage of anti-aging treatments for your face? If you buy clothing and accessories in order to convey your personal style – to portray to others the way that you see yourself – why not take advantage of available procedures to do the same for your face and body?

The Shame Of Beauty Routines Is Long Gone

As Stein points out, in the 19th century, makeup was often sold under the counter because it was considered a tool of prostitution. In the 1930s, when hair dyeing was new, women got their color done in the basements of beauty parlors so no one would see them and continued to do so for decades. The shame of these beauty routines is long gone, and I hope that in the same way, we can soon say that the days of plastic surgery shaming are over.

What is a SELFIE?

This word, first used in an Australian internet forum on September 13, 2002, is used to describe an often unflattering photograph, typically taken by the subject either with a camera held at arm’s length or in a mirror, and often shared on social media. It was the Oxford Dictionary’s word of the year in 2013, and was added to Merriam-Webster Collegiate Dictionary’s 11th edition.

Selfies Driving Increased Plastic Surgery

Believe it or not, according to a new study by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the rise of the selfie is having a huge impact on the facial plastic surgery industry. The study showed that one in three facial plastic surgeons surveyed saw an increase in requests for procedures as a direct result of patients being more self-aware of their appearance in social media selfies. In 2013, more than half of surveyed facial plastic surgeons (58 percent) saw an increase in cosmetic surgery or injectables in those under the age of 30, and this may be due in part to social media.

Is Social Media Making Us More Self-Conscious?

Many social media platforms, including Instagram, GroupMe, Snapchat and the iPhone app Selfie.im, are image-based. Our presence on these platforms forces us to see our own image repeatedly, and to look at our image with a more self-critical eye than ever before. Gone are the days of a morning farewell to ourselves in the mirror and a quick passing glance at our reflection in the Bergdorf Goodman window during the day. We are now forced to gaze at, and compare, our self-selfies and the selfies of others on a constant basis. We are more aware than ever that our photos are often the only first impressions available to prospective friends, colleagues, romantic interests and employers, and we want to put our best selfie-face forward.

In the article “Why Selfies Sometimes Look Weird to Their Subjects”, Nolan Feeney points out how the selfie can be a set up for disappointment.

Our Mirror Image Has Turned On Us

Whether or not a selfie is reversed after being shot is a major factor in how we perceive our photo. If you’ve used multiple mobile apps to take pictures of yourself, you’ve probably noticed that some, like Snapchat, show you the view of yourself that you would see in a mirror, and that others, like GroupMe, flip the image horizontally and save your selfie the way others would see you. We are used to seeing our image in the mirror, and we’ve grown accustomed to our mirror faces, and familiarity breeds liking. When our mirror image is flipped (this is what others see), it often looks strange and less attractive to us.

Our Faces Are Not Symmetrical Works of Art

Part of that is because everyone’s face is asymmetric. As photographer Julian Wolkenstein illustrates with his portraits, which duplicate each side of a face to create strikingly different versions of the same person, everyone’s left and right side is different.

Close Proximity Breeds Distortion

The close proximity of our faces to our smartphone lenses makes matters worse. Selfies exaggerate certain features, such as the nose. The parts of your face that are closer to the camera seem larger than other features in comparison to non-selfie photographs, where the distance from the camera to your face is longer and has more of a flattening effect on your face. Some people describe this as the “fisheye effect” of smartphone lenses. Bottom line? You don’t really look like that!

Do It for You, Not Your Selfie

I often have patients ask me, “What do I need?” with reference to Botox, facial fillers or plastic surgery. As I tell all my patients, you are the judge and jury as to what you “need” (and by “need” I mean “want”) in terms of cosmetic surgery. If you do decide to take the plunge, make sure to select a board-certified surgeon who specializes in plastic surgery of the face, head and neck, and make sure you’re doing it for yourself, and not just for your selfie.