How To Have A Great-Looking Chest

Whether we’re rocking a swimsuit or wearing a low-cut top this summer, we want our skin to look the best it can. Dr. Rondi Walker, board certified plastic surgeon, tells us to protect our décolletage and improve sun damage.

What happens to the skin and neck area as a woman ages?

Our skin’s main support structure, collagen, starts to break down and is difficult to rebuild. The subcutaneous fat (fat under the skin) also deteriorates. Consequently, our skin becomes drier, thinner, and duller.

Because our skin doesn’t have the volume it had when we were younger, it looses pores, follicles, oil and sweat glands and makes it less efficient and more fragile.

Skin also becomes more sensitive to light, heat and extreme temperatures, which leads to increased problems with photo aging, and the emergence of sun freckles and liver spots. Further, the incidence of skin cancer rises because our skin can’t repair itself like it used to.

What are some easy things women can do to keep their décolletage areas healthy?

First and foremost, use sunscreen to protect yourself against UVA and UVB rays. Wear SPF30 for everyday use, and SPF50 or higher if you’re going to be in the sun for extended periods of time. One of the best over-the-counter brands is Neutrogena. Our office sells SPF50 from the ZO Skin Health line, which has a titanium dioxide base. No matter what skin type you have, you need to protect it. And don’t forget to moisturize daily!

If the damage has already been done, what can a woman do to improve the appearance of her skin?

It really depends on the patient, but some of the easier solutions we provide are skincare kits from ZO Skin Health, which will brighten, moisturize, and exfoliate, or light chemical peels, such as the ViPeel. These help to counter pigment damage and improve the appearance of our skin.

What if peels and creams aren’t enough?

If the problem is deeper wrinkles or more complex pigmentation, I use a Fraxel laser, which usually requires a series of treatments. This procedure should not be done when you’re going to be exposed to the sun.

Ultherapy is a fantastic treatment for deeper wrinkles and skin laxity, but it is not used to treat pigmentation. It treats deep and superficial levels. This non-invasive, in-office, procedure uses ultrasonic energy, which causes small bombardments in the very deep level below the skin. When these areas have to heal, new collagen is laid down and the skin tightens and smoothes out. It can be performed any time of year on any type of skin and is a one-time treatment. The full effect can be seen after 90 days, and the results last about 18 months.

Ultherapy on the chest

Dr. Walker is a Board Certified Plastic Surgeon who practices in Washington, DC. See her news segment below!

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Breast Reduction Surgery “Didn’t Hurt As Much As Nursing My Kids!”

FOF Joan*, 61, has had “large breasts” her entire life. (Or at least, since puberty.) “When I was younger, it was great,” she says. “I had a phenomenal figure. They were a solid D cup—high and full… the best accessories I could ask for!” But as Joan got older, they started getting… less great. “By my 50s, I was up to a 34 DDD, and I just didn’t like the way they looked any more.” Although Joan’s weight was the same as ever—”I’ve always worn a size 8”—her breasts seemed too large—and saggy. “I had deep grooves in my shoulders from where my bra straps dug in,” she explains. “And I felt self-conscious.”

*Name changed to protect privacy.

Breast reduction and lift performed by Dr. Friedlander.

So when one of Joan’s interior design clients got a breast reduction, Joan peppered her with questions. “She looked fabulous,” Joan says now. So I got her doctor’s card.” She went to see Dr. Friedlander that March, just for a consult. “After two hours in her office, I booked the surgery that day,” she says. Here, Joan talks about her procedure, the aftermath, and what she’d tell other FOFs about breast reduction surgery.


Against Plastic Surgery? Read This Now!

Dr. Malcolm Roth is Chief of Plastic Surgery at the Albany Medical Center in Albany, New York, and former president of the American Society of Plastic Surgeons. A practicing board certified plastic surgeon for 25 years he is passionate about his profession and one of it’s most articulate spokesmen.

FOF talked to Dr. Roth about changing consumer attitudes towards plastic surgery and about changes in the field itself.

What is most rewarding about being a plastic surgeon?

We restore and enhance lives. We perform procedures in the reconstructive area that make people function better. A woman who has had a mastectomy, for example, can go to the beach looking as she did before. We work on children born with deformities and on cardiac patients who have infected wounds after heart surgery. We make people happier about their appearance and more confident about themselves.


{Life Changing Plastic Surgery Story} “Before, When Someone Complimented Me, I’d Say, ‘Yeah Right.’” Now…

Face, neck, upper and lower eyelid lift & lip filler performed by Dr. Powers.

Sonya*, 60, feels reborn. “I am so happy with my life, it’s the life I wanted.” It wasn’t an easy road for Sonya. She had custody of her ailing mother and became very depressed. “My mother had Parkinson’s and it was tough taking care of a parent who is very ill. She passed away two years ago. During that time, I was feeding my depression with food and gained a significant amount of weight,” she says. Sonya was medicated with antidepressants and desperately wanted to lose the weight. She found a chiropractor who put her on a diet and got her off the pills.

*Name changed to protect privacy.


Do Your Eyes Show Your Age? A Conversation With Dr. Rondi Walker

What most bothers FOFs about their eyes?

Patients start having concerns about their eyes when others tell them they look tired. Or when they look in the mirror and they think they look sad, tired or older than they feel.  Heavy-looking upper eyelids usually bother them most. Women also will tell me they’re having trouble putting on makeup.  Their mascara winds up on their upper eyelids, instead of on their lashes.

Does the extra skin on the upper eyelids make them look heavy?

It could be excess skin, fat or muscle in the upper eyelid. Or it could be browtosis, when the position of the brow has changed. You can’t assume the problem is simply with the excess skin, when it’s really the brow that needs to be elevated and only a minimal amount of skin should be removed.

Where should our brows be located?

Ideally, the brow sits at the level of the frontal bone, right on the brow ridge. If you take your fingers and palpate along the lower portion of the frontal bone, right above your eye socket, you’ll feel your frontal ridge. That’s where the eyebrow should sit.

What causes browtosis?

Brows begin to sit lower as our collagen and tissue thin out and gravity and laxity set in.  It can be likened to what happens to other parts of our body.  Some women also have a genetic propensity for browtosis. If their parents had it, they likely will have it, too.

The skin falling from the brow therefore crowds the upper eyelid, which causes a heavy appearance. Often, all we have to do is lift the upper brow, especially for a woman in her 30s or 40s. By 50, however, many women also need to address the excess eyelid skin.  It is important to determine if browtosis is present and treat that as well.

Which is more prevalent in FOFs: Excess upper eyelid skin or browtosis?

At least 40 percent of women over 50 have browtosis, some developing it when they’re younger.  Whether you age more in your upper or lower face depends on a few factors, including genetics and your face shape.  Narrow jaws, short necks, and thin skin are worse for aging.  The best attributes for aging are heavy, fatty faces, square jaw lines, prominent cheek bones, wide set eyes, thick lips, dark and oily skin.

What do you do with excess fat in the eyelids?

Years ago, surgeons took out all the fat in the upper and lower eyelids, removed muscle and created a hollow, deer-in-the-headlights look, which used to be considered a classic look. Over the course of the last 30 years, we realized people didn’t look good with that hollowness and we started to preserve the fat, or removed very little.

Sometimes, we reposition the fat in the upper eyelid fold to make the upper eyelid fold full.  Fat in the face and around the eye, positioned correctly, is a sign of youth. I rarely remove fat from lower eyelids unless a patient has very large bags (these are called malar bags and sit right over the cheekbone).

Can you insert fat into the eye area?

If someone is very hollow, we can inject fat into her brow roll, the temples, or the tear trough (the area between the nose and the bony rim of the lower portion of the eyelid socket). Additional fat in the lower eyelid structure provides support, smoothens out the area and gives eyes a more youthful appearance.

We lose soft tissue and fullness in the area as we age; the fat starts to migrate away and we see a little trough, or hollowness, that creates a shadow that makes us look tired and older. In younger patients, we can fill in the trough and cover the dark shadow with filler, such as Restylane. Or we can use a patient’s own body fat.

Skin is always darker under the eyelids than the skin on the rest of the face, so we naturally have a slight shadow under the eye—it is just more prominent in some individuals than others.

Are eyes usually done along with a facelift?

I rarely do a facelift without doing the eyes at the same time. Eyes alone are usually done on younger patients who don’t need facelifts.

If a FOF had her eyes done alone, would that be a mistake?

No, it wouldn’t be a mistake if that’s someone’s preference, but we wouldn’t want to overdo it by giving a patient very youthful eyes without telling her that the rest of her face might look a little more aged.

Sometimes, patients just want their upper eyelids treated, preferring to leave the lower eyelids alone.  It wakes them up, and they look more youthful. They’re perfectly happy with that. If what the patient wants is within reason, I do it.  She understands I could do more to make her look better, but she doesn’t want more involved, as well as costly, surgery.

Often, women have their eyelid surgery done first and come back for the facelift, but most surgeons offer packages, which makes it more economical to do both procedures at the same time.

Which goes first, the eyes or the face?

It depends on the patient.  Some patients come in with perfect eyes.  They have big, gorgeous eyes and they don’t have much skin excess or big fat pads.  Others have heavy jowls and excessive laxity—they need facelifts!  It depends on several factors, such as the quality of the skin, how the brow sits, and genetics. It’s a very individual thing.

Are there any 70-year-old women who don’t need work?

Women with thicker and darker skin, including Mediterranean and women of color, often age without a wrinkle, especially if they’ve maintained their weight.

Does fat cause puffiness under the eyes?

Yes, it’s usually fat.  The orbital septum becomes weaker, our muscle becomes more lax and stretched, and the collagen thins, becoming more disorganized.  Our tissues can’t hold the fat back as well as we did when we were younger and so the fat protrudes more.

I will remove a little bit of skin from the lower lids and try not to disrupt the muscle. I tend to re-suspend the muscle in older patients, using a procedure called the Orbicularis Hitch.   I hitch the muscle and tighten it to the lateral rim of the orbit to create a nice smooth line underneath the eye.

What’s the best way to get rid of fine lines and wrinkles around the eyes?

I do CO2 laser resurfacing around the lower eyelid to get rid of very fine lines and wrinkles that are caused by smiling, laughing and movement of the muscles over time. Skin becomes fine, thin and crepe-like as we age. The laser creates a superficial and controlled burn or damage that disrupts or destroys old collagen, which in turn lays down new collagen as it heals. The new skin is smoother, tighter and thicker.

Botox injections also stop the movement of the muscles that cause these fine lines and wrinkles, but the movement returns when the Botox wears out.

What are your fees for eye surgery?

They range from $3,000 to $7,500 for both eyes, depending on what you have done. Upper eyelids alone would be at the lower range; upper and lower eyelid surgery, combined with the CO2 laser and Botox would be at the upper range.

What are the dangers of eyelid surgery?

Dry eyes, ectropion (pulled down lower lid), inability to close the eyes, and in rare cases, blindness.  In those cases where blindness has been reported, it is associated with extreme pain and bleeding after surgery.  A blepharoplasty is not a painful operation.  If the patient is experience extreme pain, it is indicative of pressure build up within the orbit.  This pressure compresses the optic nerve and can lead to blindness if the pressure is not relieved.  It is easily treated by releasing all the sutures and placing the patient on medication.  There have only been a few reported cases of true blindness secondary to blepharoplasty.  These complications are extremely rare.  In general, this is a very safe procedure, and the operation most commonly performed by all plastic surgeons nationwide.


Dr. Rondi K. Walker

Walker Plastic Surgery
3301 New Mexico Avenue Northwest
Washington, D.C. 20016

Tel:  (202) 364-6673
Fax: (202) 686-0257