Intrinsic aging of the face is hereditary, and the result of genetically-controlled chronologic changes in the skin, fat, and bone that are independent of environmental influence. These visible changes reflect the combined effects of decreased tissue elasticity, volume loss, progressive bone resorption, and gravity. Other factors which contribute to aging include underlying muscle activity, hormonal imbalance, and dryness. All of these changes are enhanced by extrinsic factors such as UV radiation/ sun exposure, chemical exposure, and smoking. The gradual loss of underlying soft tissue fullness and support is responsible for the descent and relative excess of facial skin typically seen with aging. Consequently, the defining fullness and curvatures of youth are lost.
In the upper third of the face there is loss of subcutaneous fullness to the forehead, brow, temple, and upper eyelid areas, which accentuates the underlying boney structures. Loss of periorbital fullness and brow support causes brow ptosis (droop). Volume loss in the lower eyelid and weakening of the underlying orbital septum leads to protrusion of intraorbital fat to form “bags” in the lower eyelids. Skin wrinkling (frown lines and crow’s feet) results from repeated underlying muscle activity, in addition to the other changes.
In the midface, volume loss in the under eye area also leads to accentuation of the tear-trough depression. Loss of fullness between the orbicularis oculi muscle and the overlying lower eyelid skin brings these tissues into closer proximity and imparts a darker coloration to the thin infraorbital skin, resulting in a ‘tired’ appearance. The malar fat pad gradually descends to accentuate the nasolabial fold, leaving behind a cheek concavity that is accentuated by volume loss of the cheek; this also accentuates the lower eyelid-cheek junction which falls to the level of the inferior orbital rim, and aggravates the tear-trough.
With progressively increasing skin laxity and loss of malar fat volume a relative excess of skin occurs in the aging lower face, leading to loss of definition of the jawline. The malar fat pad descends, as does other facial fat, obscuring the definition of the mandibular border and leads to the formation of jowls. Drooping of the unsupported skin, chin pad, and shortening (contraction) of the platysma muscle, leads to the development of the characteristic “turkey neck” deformity with blunting or loss of the cervicomental angle. Protrusion of the fat pad beneath the chin further accentuates this neck fullness.
People are showing greater concern about their appearance as they age. The availability of advanced skin care products and non-operative treatments makes it easier than ever before to improve certain manifestations of aging and to delay the need for surgical intervention. Topical skin care products include a multitude of compounds, acids, vitamins, and hormones that help exfoliate, lighten hyperpigmentation, repair damage, increase epidermal cell turnover, and provide antioxidant activity to reduce and prevent further damage. Skin care products complement all other facial procedures and are an excellent way to improve skin health. Non-operative treatment alternatives offer individuals the ability to take a more active role in preventing age-related changes, offer the opportunity to delay the time to surgery, and are an option for those individuals who either do not want surgery or in whom a surgical procedure is contraindicated.
With a safety record that spans more than 20 years, botulinum toxin is extremely effective for naturally shaping the brows and correcting frown lines, crow’s feet and transverse forehead creases. Patients remain enthusiastic about the dramatic results that can be achieved with regular BOTOX® Cosmetic injections.
With the introduction of hyaluronic acid dermal fillers the improved longevity of results, ease of injection, and proven safety and efficacy have led to widespread use and acceptance of these products. Hyaluronic acid fillers are effective when injected into all facial areas for many different indications. They can treat static lines in the glabella, correct the tear trough deformity, augment the cheek, improve the nasolabial folds, soften vertical lip lines, restore fullness to or augment the lips, and restore volume to the marionette lines, jowls, and chin. Other synthetic filler products can be used in similar ways, as can autologous fat grafting with nice results.
One filler or injectable obviously does not fit all situations, but in combination fillers can often produce better results than using one product alone. The combined use of multiple injectables-ranging from BOTOX®, to prepackaged soft tissue fillers, to fat-permits volume rejuvenation of most facial areas without excisional surgery.
For many of us, however, there comes a time when further conservative and non-surgical procedures do not provide adequate gains and surgical intervention should be considered.
Recognizing changes that occur in the aging upper face is fundamental to rejuvenation of the forehead and periorbital region. The presence of forehead or brow ptosis should be evaluated in all individuals who appear to have a redundancy of upper eyelid skin. One is then able to determine if forehead ptosis is present and decide whether a brow lift, eyelid surgery, or a combined procedure is most appropriate.
The age-related changes of the face and neck can be improved with a face lift or neck lift if non-surgical procedures are not indicated. Many face lift techniques exist, but all seek to improve the visible signs of aging, by removing excess fat, tightening and/or lifting the underlying muscles or supporting structures of the skin, and removing excess skin. Short scar face lifts will improve the lower and middle thirds of the face, utilizing an incision placed in front of the ear. These procedures are best for individuals who exhibit mild to moderate signs of aging without excessive skin laxity. For those with more severe aging, a full face and neck lift will be required to adequately address the skin laxity, neck bands, and loss of underlying support. Additional incisions are incorporated behind the ear and under the chin to assist with contouring and tightening.
Other aesthetic facial procedures used to improve the shape of the nose or ears are often performed because of an individual’s dissatisfaction with their appearance, and not due to changes associated with aging. Patients who seek these procedures may be younger than those seeking rejuvenation treatments.
Rhinoplasty is designed to improve the appearance of the nose by reshaping the underlying cartilage and bone. Cosmetic rhinoplasty can reduce a nose that is too large or wide, improve a dorsal hump, and refine the shape of the tip. If the nose is crooked, or if airway problems exist, reconstructive surgery may involve modification of the nasal septum. Individuals with large or misshapen noses often experience anxiety about their appearance, but they report significant happiness and enhanced self-confidence after rhinoplasty.
Prominent ears can detract from facial appearance and result in lack of self esteem. Plastic surgery of the ears is most commonly performed to correct the position of ears that are too prominent and protrude from the sides of the head; this procedure is called otoplasty. Such protrusion may occur on one or both sides, and makes the ears appear to be larger than normal. More than half of all the surgeries to correct prominent ears are performed on children, many at about the time they enter school. Young adults who have suffered with prominent ears experience great satisfaction following otoplasty.
At Cosmetic & Plastic Surgery Specialists we offer a wide variety of surgical and non-surgical options for facial rejuvenation. If you need additional information to decide which is best for you, please contact us or call 414-443-0033 to schedule a consultation.