In the U.S. it’s inevitable, we’re perpetually dieting, working­out, chasing that “sweet bird of youth” but for what purpose? The health benefits are indisputable. Fitness becomes a lifestyle choice and a hedge against middle age “spread”. Most of us are not experts and entrust our bodies to personal trainers and our diets to the persuasive messages of Dr. Oz, the latest pressed juicery or alas, the HCG (Human Growth Hormone) diet clinic. I admit that even I have been tempted, although eventually good sense prevailed or the spirit was weak. The net result is one of dissatisfaction for the status quo and nostalgia for days gone. The inexorable nature of change is what brings patients to consultation; together we continue to test solutions to so­-called problems.

The satirical RHOC franchise establishes that “housewives” in the OC are monomaniacal about maintaining their youth and beauty. Why? The series establishes a “pecking order”, in which beauty and youth are commodities, which confer power and influence. So what does the average Jane do? Spin, juice, pilates, cleanse, Cross­Fit, calorie restriction. Fat is not the same in all parts of the body. Certain fat deposits are “diet resistant”, hormonally stimulated and genetically specified. Patterns of facial lipoatrophy have been elucidated to occur in specific zones (temples, tear­trough, buccal fat pads, etc.), ontogenetically determined and accelerated by weight fluctuations. Alas, feminine characteristics (full cheeks, lips and round temples) melt long before “muffin top” and “pot bellies”.

So what is “work­out” face? It has many deflationary aspects, “peanut” brow, tear troughs, hollowing around the orbital bone, disappearance of the cheek & buccal fat pads, shrinkage of lips, “fish gills”. Historically, this form of facial aging was treated by facelifts. Thin faced individuals were elated, 3 weeks post­op, when post­op edema restored a “baby face” but results were transitory. Today, the liquid facelift is much in demand and like anything else needs accurate diagnosis & planning, expert technique and repetition. The principles can be applied to both men and women although reflationary plans should be gender specific and not “overfeminize”.

The type and combination of fillers and/or neuromuscular toxin used varies widely but frequently “polypharmacy” (multiple types and amounts) are often required. Happily the down time, cost and complications are generally less than surgical procedures. Longevity ranges from 6­18 months but this impermanence allows interval adjustment which reflects my experience with a cadre of satisfied patients. Remember, like anything well worth doing, practice, practice makes perfect.

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