Aging is nothing more than the body’s physiologic process in response to a duration of time. Since some do not age as gracefully as others, people have sought treatments to either slow or reverse this aging process, with little success. This process can be accelerated by many factors including long-term sun exposure or smoking, but aging cannot be stopped or reversed. However, with appropriate care of the skin and layers of the face, these aging effects can be reduced. Attempting to make a 55-year-old look 30 is not only unreasonable but impossible; while making a 55-year-old patient look 10 years younger is reasonable and attainable.
When thinking about what is actually happening to the aging face, one must think about three things. One, there is a loss of soft tissue volume (fat atrophy) throughout the face leading to a deflated appearance. Second, the bones of the facial skeleton undergo slow resorption along with the loss of dentition (teeth) contributing to a hollowed appearance. Lastly, the skin and facial soft tissues show signs of aging with descent causing both fine and deep wrinkles (rhytids). In order to property attempt to create a more youthful appearing face, surgeons must address all three of these critical contributing factors. A youthful face has a taper similar to an upside-down egg with the middle third of the face full of volume, while the aging face is characterized more like a reverse taper or right side up egg as the facial soft tissues that were once higher in the face are now much lower.
Various surgical and non-surgical treatments are aimed at mitigating these changes; therefore, addressing each area of the face with the possible solution is the best approach.
When thinking about what is actually happening to the aging face, one must think about three things. One, there is a loss of soft tissue volume (fat atrophy) throughout the face leading to a deflated appearance. Second, the bones of the facial skeleton undergo slow resorption along with the loss of dentition (teeth) contributing to a hollowed appearance. Lastly, the skin and facial soft tissues show signs of aging with descent causing both fine and deep wrinkles (rhytids). In order to property attempt to create a more youthful appearing face, surgeons must address all three of these critical contributing factors. A youthful face has a taper similar to an upside-down egg with the middle third of the face full of volume, while the aging face is characterized more like a reverse taper or right side up egg as the facial soft tissues that were once higher in the face are now much lower.
Various surgical and non-surgical treatments are aimed at mitigating these changes; therefore, addressing each area of the face with the possible solution is the best approach.
The Forehead and Brow:
The youthful appearance of a forehead is that which is smooth with static rhytids (wrinkles), however dynamic rhytids are inevitable and easily treated with neurotoxins such as Dysport® or Botox®. The brow of a young man should lie at or slightly above the superior (upper) orbital rim, with time this will descend due to gravity. This, coupled with atrophy of fat leads to an excess skin of the upper eyelid (hooding) giving the eye a smaller appearance. Ultimately these changes uncorrected give the patient the appearance of a sad or tired look. To reverse these changes the patient can undergo an endoscopic or traditional brow lift procedure. Often patients compensate for this brow ptosis or sagging by unintentionally raising their brow, which if not properly diagnosed the patient may undergo only an upper eye blepharoplasty (eyelid lift) rather than a brow-lifting procedure which will likely only make the problem worse.Upper Eyelids:
As mentioned previously, the upper eyelids are intimately tied to the brow, forehead aging, and rejuvenation. Two things patients will notice with their upper eyelids are redundant (excess) skin and hooding of their upper eyelid along with bulging of the fat behind the skin. With years of opening and closing the eyes we all develop fine rhytids or wrinkles next to the eye called crow’s feet, which are again easily treated with the neurotoxin such as Dysport® or Botox®. The surgical treatment of the upper eyelid includes blepharoplasty (eyelid lift) and brow-lifting if needed and skin resurfacing with lasers or chemical peels.To be continued.
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