Are the years taking a toll on your face?

South Florida doctors have an ever-growing arsenal of youth-enhancing procedures to help turn back time for savvy patients.

“Twenty years ago, there was only one remedy for facial aging, [facelifts] ,” said Dr. Stephan Baker, a Coral Gables plastic surgeon and spokesman for the American Society of Plastic Surgeons. “Today we have a whole spectrum of how we can approach aging.”

Injectable dermal fillers like Restylane and Juvederm, as well as muscle relaxers like Botox and Dysport, have become the most popular methods today to add volume, smooth wrinkles and enhance youthfulness, doctors say.

But some South Florida plastic surgeons and dermatologists are expanding their repertoire to include new options, such as injecting fat or stem cells into the face, as well as using ultrasound technology to tighten sagging skin. “I’m doing a lot of fat,” said Dr. Constantino Mendieta, a Miami plastic surgeon and spokesman for the American Society of Aesthetic Plastic Surgery, who is using fat as a natural way to add volume to the face. As we age, we tend to lose fat from the face, as well as from the hands, derriere and breasts, Mendieta said.

The fat-grafting process, he said, begins with the removal of about a tablespoon of fat from a patient’s lower stomach or inner knees.

Mendieta then takes some blood from the patient and spins it to get platelet-rich plasma, which he mixes with the fat to help the fat survive longer.

“If I can get that fat cell to live, it will live as long as that fat cell was destined,” he said. “And some fat seems to live forever.”

The fat can be injected into the lips or nasolabial folds, which run from each side of the nose to the corners of the mouth, as well as into the hollows of the eyes or the jaw line, to create a more youthful look.

“I think it’s better for people, because it’s their own fat,” Mendieta said. “It looks extraordinary.”

Similarly, Dr. Leonard Tachmes, a Miami Beach plastic surgeon, is injecting stem cells into the face as an additional treatment along with fat transfer.

“The newest, hottest topic on the market is using the patient’s own stem cells to reinject into the face,” Tachmes said, adding that recent research has shown the highest concentration of adult stem cells are found in someone’s own fat.

Tachmes begins by removing fat from a patient’s abdomen, love handles or outer thighs, under local anesthesia, or with general anesthesia, during a facelift.

He then injects the fat into the patient’s face. At the same time, he sends a portion of the fat to a lab in Indiana where the stem cells are separated from the fat. The lab will place the stem cells in syringes and return them to Tachmes within two weeks, or else cryopreserve them and store them indefinitely to use for a future treatment.

Tachmes injects the stem cells into the wrinkles around the patient’s mouth, on his or her cheek or on the forehead.

The stem cells “stimulate increased blood supply to the area, and stimulate collagen formation to make the face look fuller and healthier,” Tachmes said.

It takes a few weeks to a month to see the results.

“The patient looks more natural,” he said, “because it’s a slowly evolving process.”

Baker, the spokesman for the American Society of Plastic Surgery, said fat grafting — originally developed for patients who had lost facial fat due to HIV drugs — is now an established treatment to restore volume in the face, along with dermal fillers.

“The concept behind that is to restore volume that some patients lose as they get older,” Baker said. “Sometimes it helps to avoid face-lifting until they get further along in aging.”

But he cautions that stem cell injections, while not harmful, are as yet scientifically unproven, so it’s too early to know the benefits.

Also new on the market is Ulthera, which uses ultrasounds waves to tighten skin.

“Ulthera is really the newest and greatest thing, and not than many doctors have it,” said Dr. Leslie Baumann, chief executive of the Baumann Cosmetic and Research Institute in Miami Beach. Baumann writes a column for Tropical Life.

Her office has handled more than 600 patients, and the procedure has produced positive results in 90 percent of the cases, she said.

Ulthera, which is FDA approved for tightening the jowls of the face, works by using two different beams of ultrasound waves. The two beams come together, and the friction of the beams causes heat, which makes the collagen shrink, she said. The procedure doesn’t diminish the amount of collagen, it just makes the collagen shorter. Collagen is like a net, and if you shorten the fibers in the net, it tightens it.

“Collagen is like a spring — like a helix, and whenever you heat it, it shortens the length of the collagen,” she said, “which causes tightening of the skin.”

It takes three months to see the results, and the tightening is permanent, she said.

More new youth-enhancing procedures are on the horizon during the next few years, said Baumann.

“There are all kinds of great things coming,” she said, if the new injectables, lights and lasers are approved.

In the meantime, whichever procedure you choose, doctors advise doing some research first.

“It’s an art, so you have to find a doctor that is an artist,” Baumann said. “When you see someone with big lips or big cheeks, ask who their doctor is — and then don’t go to that doctor.”