Facial Aging

Facial Cosmetic Surgery

Aging of the face can start as early as 20 years old and continues throughout your life.  How fast you age and to what extent really differs from person to person.  Genetics and lifestyle play a big role in the aging process.  For ages, people have been looking for ways to keep their face looking more youthful.

Today there are many things that can be done to achieve a younger appearing and more youthful face.  From a host of over the counter creams, microdermabrasion, chemical peels, lasers, Botox/Dysport, facial fillers and cosmetic surgery are only a few of the many things that are being done to help rejuvenate the aging face.  Which treatment is used depends on many factors.  There is not one treatment that is used for every patient.

photo of different generations of women

Aging of the Face and Neck

In order to understand how we make decisions on treatment we first must understand how the face ages. Understanding how the face and neck age is made easier when we look at the different anatomic structures of the face individually.  These anatomic structures include:

  • Forehead & Brows
  • Upper Eyelids
  • Lower Eyelids
  • Cheeks/Midface
  • Lips & Smile Lines
  • The Lower Face & Neck
  • The Skin

Forehead & Brow

woman lifting forehead

As the forehead ages, it often becomes thinner and loses its elasticity.  This causes the eyebrows to seem to fall into a lower position of the face.  This will contribute to the extra skin buildup above the upper eyelids.   So many of our patients will come it to our office and will do the exact same move as illustrated in the picture above. They are trying to get the eyebrows back into a better position.  A female eyebrow should arch above the underlying bone which gives a healthier and more youthful appearance.  When the brow drops it flattens out and gives an aged appearance.

As we use the muscles in our forehead for animation, lines/wrinkles tend to develop.   Genetics, sun damage. and smoking are a few of the things that can dictate how deep these wrinkles are.   As seen in the picture above, injections such as Botox can help reduce these wrinkles.

Upper Eyelids

Excessive skin accumulation above the upper eyelids gives a very aged and tired appearance.  Just like the forehead, the skin of the upper eyelids also becomes thinner with age and loses its elasticity.  This in combination with the descent of the eyebrow causes build up of skin that often times will hang over the eyelashes and can obstruct superior and lateral vision.  Lastly, the upper eyelids have a septum that gets weaker with age.  As this occurs, the underlying fat pads tend to protrude forward giving a full/baggy appearance.  All of these findings can be seen in the picture of our patient below.

an old ladyan old ladyThis patient had a brow lift, upper & lower eyelid surgery, and laser resurfacing.  This opened up her eyes and makes her look so much younger. She can see much better because the overhanging skin obstruction is gone.

Lower Eyelids

So many people come into my office and state that they don’t like how tired they look.  The most common reason for this is the bags/dark circles that have developed under their eyes.  The lower eyelids have 3 fat deposits just below the skin.  With age the septum weakens, allowing these fat pads to bulge forward.  This bulge in combination with the build up of skin causes the aged and tired appearance.

Our patient here underwent upper and lower eyelid blepharoplasty.  The upper lid incision is hidden within the crease of the upper eyelid and the lower lid incision is made on the inside of the lid.  We can see how this opens up her eyes and gives her a more beautiful and youthful appearance.  She no longer looks tired because the bags are gone!

a woman's facewoman's face

Midface

Aging of the midface starts early in life.  Some of these changes can be seen as early as 20 to 30 years old and continues throughout life.  When you look at the face of a young person you will notice good facial volume.  Unfortunately, gravity takes over and everything starts to droop.  The muscles and fat of the cheek tend to shrink and fall.  This can cause a hollow appearance of the cheeks and deep folds to develop around the mouth.  These folds, called the nasolabial folds and marionette lines, become deeper and jowls around the chin develop as we get older.  Even the bone supporting the cheeks and the cartilage of the nose changes with age.  This can cause less check volume and can cause the tips of the nose to look as if it is drooping. Looking at the pictures below you can see how the kids have much more volume than there older counterparts.

people aging photos
There are several ways to try to rejuvenate the midface.  These all focus on trying to restore the facial volume.  This can be done with filler placed into the cheeks and/or folds or repositioning the fallen tissue with a facelift.

middle age womanmiddle age woman
This patient was treated with forehead lift, facelift, upper and lower eyelid surgery, and laser ablation.  The depth of her nasolabial folds and marionette lines have decreased by repositioning the tissues during the facelift. 

Lips & Smile Lines

Over time, the lips lose the full/plump look that they may have had at youth.  With age, the upper lip will elongate and loose the youthful curves.  The corners of the mouth will often times turn downward giving an appearance of constant frowning.  Additionally, wrinkling develops around the lips giving them an aged appearance.  Smoking often times will make these wrinkles deeper.  All of these findings can be seen in the pictures below.

old and young lips

 Treatment of the aging lips can include fillers, Botox, chemical/laser/mechanical resurfacing procedures.

woman getting a botox injection

The above patient is having a filler placed into the lips to create more lip volume.  By increasing lip volume, the wrinkles around the lips will also be decreased.   
woman

The Lower Face & Neck

Nothing makes a face look older than large jowls and a turkey neck.  I don’t know how many times someone comes in for a consultation and pulls this excessive skin away and says, “I want to look this way again!”  As stated above, as we age we lose facial volume and the skin loses its elasticity.  This causes the skin to drop and form the jowls and skin accumulates on the neck.  Additionally, with age we see the desiccation of the platysma muscles which causes the band like appearance of the neck.

There are several options to improve the lower face.  Botox, fillers, lasers are many of the simple things that will help to improve lower facial aging.  However, nothing matches the effects of a lower facelift.   When I do lower lifts I pride myself of trying to make it look natural.  The stretched look is definitely a sign of a poorly done lower lift.

The patient above had a lower face lift which got rid of her jowls and improved her jaw line and skin accumulation on the lower face.
midle age womanmiddle age woman

The Skin

There are many factors that cause the aging of the skin.  Intrinsic factors, from our genetics, and environmental factors both contribute to how our skin ages.  There is not anything that we can do to change our genetic makeup, but we can do a lot to help the skin changes that occur from our lifestyle choices.  Protecting our skin from the sun, not smoking, eating healthy, exercising and good skin care with cleaning and moisturizing regimens are but a few things that can help keep the skin youthful appearing.

As we get older our skin becomes thinner and drier.  The elastin becomes weaker causing the skin to sag, stretch and to not snap back after stretching it out.  Photodamage of the skin can cause fine and coarse wrinkles, roughness, as well as pigmented lesions.  This is seen in the pictures shown below.

senior lady

Fortunately, there are many treatments to help improve the aging skin.  Technology has made it possible to turn back the clock and undo some of the damage that we inflict on our skin.