THE AGING FACE – What it means, and how to slow the process

Aging is unavoidable if we wish to enjoy longevity. Thankfully, how we age as it relates to the appearance of our face is controllable to a great degree.

We are living in an era during which board-certified plastic surgeons have many excellent tools available to them to slow the aging process and improve the canvas so to speak. It does require some restraint to create the most natural looking and beautiful results. With so many treatments to choose from, some forget that these treatments need to be individually designed to each patient’s unique version of aging.

Facial aging is a complex process. I honestly believe when patients understand more about what is going on with their face, it becomes easier for them to embrace treatments that actually work. While we still do not have a “one-shot wonder” or any “magic potion in a jar,” the synergistic effects of various types of treatments used in the proper balance can be truly amazing. The reason multiple types of treatments are generally necessary is due to the fact that the face ages in multiple ways.

When we think of an aging face, we generally think of wrinkles. Wrinkles occur because of sun damage and the consequent thinning of the collagen layer in the skin that causes the skin to resist gravity and muscles pulling on it less well.

Wrinkling is generally treated with topical skin care, light-based therapy such as broad band light, and BOTOX® which weakens the strength of the muscles pulling on the skin, so wrinkles become less deep. Scientifically based topical skin care, such as products from SkinCeuticals, thicken the collagen layer by stimulating the collagen repair mechanism and increasing exfoliation so younger healthier looking cells are on the surface. Broad band light therapy, sometimes called Photofacial removes red and brown pigment in the skin that makes the skin look weathered and splotchy. This treatment does not require anesthesia and comes with no downtime. It doesn’t get much better than that.

Another sign of facial aging is the loss of volume. This happens in the fatty layer, and at the bone level. As the bones recede, there is less support for the skin and the muscles. The muscles then work harder to close our eyes and mouth. This can result in an almost cartoonish appearance. Restoring volume can be done with fillers or fat. I strongly prefer fillers as they are more customizable and more predictable than fat injections. I can artfully sculpt the face with filler whereas, with fat, some takes, some doesn’t, and resorption can be a big issue, necessitating additional treatments. The other reason I prefer filler over fat for restoring lost volume is filler looks and acts more like bone when it is placed properly than fat does. Fat is soft and doughy and does not convey the angularity and structure that needs to be recaptured. A doughy face does not convey a healthy and vital appearance like a well-rejuvenated face does. Replacing like with like is a good tenant to live by as it relates to anti-aging treatments.

The hyaluronic acid based fillers I choose to use are natural to your system, and in the unlikely event you do not like the result, I can dissolve them with an enzyme. When I operate on patients that have had permanent and semi-permanent fillers injected by other practitioners, I am frequently amazed (and somewhat consternated) by the havoc these products wreak with the natural anatomic tissue planes. This makes the surgery technically more challenging. I understand the idea that those types of filler create a more lasting result, but sooner or later, gravity takes its toll, and surgery becomes necessary. I recommend avoiding these types of fillers.
On the topic of volume restoration, I feel strongly about using the smallest volume possible to replace what lived in any area of the face before the aging process took hold. Over-filling looks uniformly bad on everyone. We have all seen people who have succumbed to this style of injecting, and it is frankly scary! Beware the injector who may be on a commission. The more they pump in, the more money they make, and in some cases, aesthetic judgment appears to go out the window.

Sagging in the cheeks, jowls and neck occur because the skin and muscle gets thinner and weaker and the bones are getting smaller, thus provide less support. When there is true tissue sagging and laxity, surgery is the best option. While there are myriad treatments advertised promising immediate and long-lasting results from in-office treatments with radio-frequency and ultrasound, I have not at all been impressed with the results. It is true you get to skip the anesthesia required for well-executed facial rejuvenation surgery, but to my eye, you also get to skip out on anything other than the most fleeting results!

I recently attended a talk where a professional speaker for one of these devices admitted that the results are generally somewhat underwhelming and short-lived, but he doesn’t mind because it forces people to realize they need surgery to accomplish the results they desire. How about we discuss that fact up front and skip the unnecessary and expensive ineffective options?

As you can tell by the length of this article, the aging process is a complicated one, and you really need a qualified professional to examine you and discuss your options. I feel a board certified plastic surgeon is that professional. I spend a great deal of time educating my patients about what treatments I feel will provide them with the results they desire, and I avoid providing gimmicky treatments that I don’t have confidence in. Remember, beauty is BALANCE, and utilizing a variety of tools to treat the different types of aging that occurs— always provides the most natural results.
I would love to see you in consultation to discuss your options and get you started on the path to obtaining the best you— you can be…at any age.

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