Facial plastic surgery in Cincinnati, Ohio

Things I Have Learned About Aging Well

This blog post is adapted from multiple sources (references below) and summarizes some things I have learned over the years about aging well that I have tried to incorporate into my life.

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Aging Well Means Maintaining Function

Fara and I had an opportunity to give a talk on aging well at a country club. It was very gratifying to impart whatever wisdom I could to interested individuals.

The World Health Organization (WHO) defines healthy aging as the process of developing and maintaining functional ability with age. Genetics, the environment, and human behavior all contribute to healthy aging. Healthy aging is distinct from changes to our appearance which can occur with age. Functional decline may or may not parallel the development of an aged appearance. For example, there are many high-performance athletes, such as triathletes, who maintain high functional abilities into their old age but whose faces appear older due to factors that will be discussed.

Lessons from the "Blue Zones" Have Been a Helpful Guide

“Blue zones” as defined by the author of The Blue Zones: 9 Lessons for Living Longer from the People Who’ve Lived the Longest, Dan Buettner, are areas of the world where the number of people living into old age is much higher than average. The communities identified are in Japan, Costa Rica, Italy, Greece, and Southern California. The author and his colleagues visited these communities and distilled the qualities that they believe are likely contributing to their longevity into 9 “lessons” for others to follow.

A Culture of Physical Activity is Essential

The behavioral traits identified in these blue zones include a culture of physical activity. However, this is not simply regular exercise, though both aerobic and strength training are recommended. The individuals in these communities live in a built environment where exercise is easy and performed passively and physical activity is required to perform activities of daily living. This includes walking to school, the market, and friends’ homes.

I completed fellowship training in facial plastic surgery in New York City. My wife, son, and I lived in Queens during this time. The community we lived in was composed of medium-height buildings spaced close together. The nearby parks were beautiful, safe, and child friendly. Our friends lived within walking distance. All our necessities were within walking distance. I traveled to work on the subway system, which required walking a few blocks each day. The fact that we lived in a small apartment seemed less important because we could live our lives in the city. It was easy to maintain our physical health while enjoying our lives. A short commute was invaluable, because I worked very long hours and would otherwise been unable to see my wife and son before they went to bed if I had a long commute by car. The walkability of the community we lived in improved our quality of life greatly.

In contrast, my time teaching in Doha, Qatar for Weill Cornell Medical College in Qatar provided a very different lifestyle. I lived in downtown Doha in a high-rise apartment. The university was located a 30-minute drive away on the outskirts of the city in the desert. Temperatures reached the 100s to 110s daily, even at night. As a result, outdoor activities were severely limited during the day. We lived inside air-conditioned buildings all day, albeit very nice ones. I scheduled time to work out in my building’s gym to maintain my physical health. But it was not easy. Work was time-consuming and I wanted to take as much time to explore a part of the world I previously knew so little about.

One consideration I would add to a culture of physical activity is optimizing ergonomics. A surgeon spends most of their day standing or sitting in somewhat contorted positions. The potential for this to put strain on the shoulders, back, and hips is significant. It is important to maintain an exercise regimen that keeps a strengthened core and to constantly focus on proper body positioning when operating. After all, we owe it to our patients and ourselves to maintain peak physical health to optimize our surgical outcomes. To that end, I practice pilates to maintain my core strength.

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Strong Social Support Contributes to Aging Well

Some of my family and me at the Trains and Traditions Exhibit at the Krohn Conservatory in Cincinnati, Ohio.

Another behavioral trait identified was a strong social structure. This includes strong family connections, friendships, and support from their community groups. When my wife and I returned to Cincinnati from New York City we realized how much we missed being near family. Our son, Babak, suddenly had his grandparents nearby. It was very helpful for us as we established Harmon Facial Plastic Surgery. The relationship Babak has built with his grandparents has meant so much to Fara and me. I believe it has help developed Babak’s emotional intelligence and happiness. I hope our soon-to-be-born daughter, Roya, will have a similar experience.

Good Nutrition is Whole and Balanced

A third behavioral trait relates to their cultures of food and nutrition. I would like to reference this blog post on nutrition written by the dietician Tirzah Thompson who presented at our office in the past. Individuals in blue zone communities eat a well-rounded diet of whole foods, avoiding processed foods. They eat to contentedness only while maintaining adequate calories for nutrition. The information provided by Tirzah Thompson and the blue zone communities does not account for individuals with micronutrient deficiencies due to disease and/or food allergies and intolerances. Any diet should account for these differences and be culturally appropriate/sensitive.

I have really enjoyed learning about Persian food and the culture surrounding it from my wife and her family. Persian food is complex and beautiful, consisting of stews filled with unusual spices. It takes hours to prepare but is well worth the wait. The wisdom gained from years of trial and error is evident in the combination of ingredients and the care with which it is prepared. My favorite dish is called ghormeh sabzi which consists of a mixed of herbs including parsley, cilantro, scallions, and fenugreek as well as kidney beans, beef and a special dried lime commonly used in the region in teas and to impart additional flavor to a stew. The stew is over over fluffy long-grain rice tossed with butter and saffron. The taste is slightly citrusy and bitter, and the aroma is unlike anything I have previous experienced. That is the case with most Persian dishes. Persian cooking, like cooking from all over the world, contains generations of embedded wisdom that make eating a well-rounded diet easy and the experience enjoyable.

Adequate Sleep Can be Difficult but is Necessary

An area unmentioned in the blue zones studies was the importance of sleep. The American Academy of Sleep Medicine recommends 7 or more hours of sleep per night regularly. The academy allows 9 hours of sleep per night for individuals who are recovering from an illness or who have been deprived of sleep. I understand that 7 hours of sleep per night regularly can be more difficult at different times in our lives. For example, our sleep can be limited when caring for young children and/or our elderly relatives whose functional capacity is limited. Our jobs can also limit our sleep. I have certainly felt this way during residency and fellowship training and when our son was just born and waking regularly to feed. I have learned that life is a long, beautiful journey. We cannot always be perfect to ourselves or for our loved ones.

The Skin Ages

Functional decline may or may not parallel age-related changes to appearance, including of the skin. The changes related to skin aging develop due to both external and internal factors. The internal factors are genetic and a relatively minor contributor to skin aging. Most age-related changes to the skin are due to external factors, none more so than cumulative sun exposure. Other external factors include smoking, excessive alcohol intake, poor nutrition, and pollution. These external factors contribute to skin aging by accelerating a chemical reaction in the skin that leads to a breakdown of its components.

There are three components of skin whose changes contribute to aging. The first is collagen, which is the skin scaffold. The second is elastin, which imparts elasticity to the skin. The third are glycosaminoglycans (GAGs), of which hyaluronic acid is an example, which increases skin hydration and plumpness.

Aged skin appears more fragile, thin, wrinkled, dry, rough, sallow, and with poor light reflection and pigmented spots. Necessary but not sufficient, good skin care can both treat and decrease the effects of aging on the skin. A good skin care routine is simple and includes agents that are pro-collagen, antioxidant/anti-inflammatory, and photoprotective.

Topical Retinoids are Pro-Collagen

Retinoids, which include retinols, are derivatives of Vitamin A that can be applied to the skin. Topical retinoids are pro-collagen, meaning they increase the production of youthful collagen and reduce the breakdown of collagen. Retinoids, a prescription medication, are the only FDA-approved treatment for photoaging. Retinols, a precursor molecule that is converted to retinoids in the body, are not FDA-approved; rather, they are a cosmeceutical. Retinols do not require a prescription. While not FDA-approved, there is extensive evidence for their effectiveness as well. Retinoids and retinols are unique among skin care products in that there is evidence both that they can reverse and prevent some of the signs of skin aging. Retinoids do have some side effects and may not be appropriate for all individuals or all skin types. A consultation with a dermatologist or plastic surgeon is recommended prior to considering the use of retinoids of any kind.

Topical Vitamin C is Anti-Inflammatory and Photoprotective

The most important topical antioxidant/anti-inflammatory product – the product with the most evidence for its effectiveness – is ascorbic acid, also known as Vitamin C. Vitamin C is an important component of collagen. There is strong evidence for its effectiveness as a topical antioxidant, which reduces the frequency of the previously described chemical reaction on the skin. It is also photoprotective, reducing the effects of ultra-violet rays from the sun. The problem with Vitamin C is that it requires a specific formulation to be adequately absorbed by the skin. It is also exquisitely sensitive to light and air, necessitating special packaging. Other ingredients are often added to Vitamin C that preserve the function and even potentiate its effects, including tocopherol (Vitamin E), ferulic acid, and pycnogenol. These ingredients, including topical Vitamin C, are all cosmeceuticals which are not FDA-approved to treat photoaging. All necessary precautions should be taken when using these ingredients as they may not be appropriate for all individuals or all skin types. A consultation with a dermatologist or plastic surgeon is recommended prior to considering the use of these treatments.

Sunscreen is Photoprotective

The best photoprotective product for the skin is sunscreen. The best sunscreen to use is a mineral-based sunscreen, such as one that includes zinc oxide. Chemical-based sunscreens rarely provide as strong and complete protection. Recommendations include a mineral-based sunscreen of at least an SPF of 30 or greater.

Trust Your Face to a Facial Plastic Surgeon

It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about age-related changes to your face and/or neck.

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  1. Baumann, L. (2014). Cosmeceuticals and Cosmetic Ingredients (1st ed.). McGraw Hill/Medical.
  2. Buettner, D. (2012). The Blue Zones: 9 Lessons for Living Longer from the People Who’ve Lived the Longest (2nd ed.). National Geographic.

This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.