Haideh Hirmand, plastic surgeon
What she's doing to her skin right now: "I do Botox every few months in my forehead, but not too often. I don't have a lot of deep lines, and I don't want to get rid of all my fine lines, but Botox gives me a brow lift effect. And I think it has prevented the lines in my forehead from getting really deep. I also do Restylane, one of the hyaluronic acid fillers, in my nasolabial folds (the lines from my nose to my mouth) and the lines around my lips. About once a year, I inject it in the hollows under my eyes as well—and that has given me the most dramatic results of anything else I've tried. I was starting to look tired all the time, and now I look, and actually feel, more rested."

What she might do to her skin one day: "More fillers. I'm starting to lose fullness in my face, so I'd consider doing a fat transfer or a hyaluronic acid filler other than Restylane, if something longer-lasting comes along. I'd also consider a surgical brow lift. And liposuction. I'm fit, but as I've started losing fat in my face and neck, I've been gaining it in my lower abdomen and hips. So I'd consider some conservative liposuction contouring in those areas. Before I did a full facelift, I'd try one of the nonablative tightening techniques, like Thermage or Titan. I don't perform them in my practice, but I think they're going to get more and more effective in the next few years."

So no facelift ever? "I'd consider it if I thought I would still look appropriate for my age. I don't think you can look like someone who's 30 when you're 60; you can only look like someone who wants to look 30."

What she wishes she'd done earlier: "Used antioxidants and sunblock as religiously as I do now."

What she'll never do: "A permanent filler, like silicone. Your face is dynamic. It's a big mistake to put something permanent in something that changes."

The biggest misconception her patients have: "A lot of them think the fuller the better. The new filler technology has given us tools we never had in the past, but it doesn't mean you shouldn't have any lines or folds on your face. Especially because your skin thins as you age, if you overdo it with fillers, you can start to look like a blowfish."

What she's looking forward to: "I think the minimally invasive tightening technology will become much more effective. I'm also excited about better, long-lasting, absorbable suspension sutures for facelifts. Right now the verdict isn't in on thread lifts. I believe eventually we'll have a better, more advanced version of that technology, though."


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