The Science of Facial Aging

Aug. 3, 2009 - PRLog -- Beauty and aging are intrinsically linked neither dependent on each other.  While beauty is a concept that is ethnically, racially and culturally determined, the aging process is slow, relentless and irreversible.  Aging occurs at different rates from individual to individual as well as in each person at any given time.  It is related to a combination of loss of bone, fat, collagen and elastin, each of which is directly related to genetic composition and environment.  During the course of this aging process the general outline of the face changes from a triangle with the apex pointing downward to a trapezoid or rectangle due to sagging skin and downward descent of the cheek soft tissues. This change in geometry is more evident in the female face. It appears to be unrelated to general physical activity unless one is very ill and bed ridden.

General changes that occur with facial aging include:

FAT LOSS

For many years we thought that the human face aged uniformly. We now know from the work of Dr. Pessa that fat disappears from different fat compartments in the face at differing rate.  Most cosmetic doctors now agree that the rate of fat disappearance is directly related to how the face ages.  
20-30 years Fat begins to disappear from under the eyes. Dark shadows cause us to look older and tired.  Correction: Hyaluronic acid to lower eye area
30-40 years Malar fat pad descent begins. Nasolabial lines appear. The result is wrinkles and jowls in the face. Those due to muscle motion are referred to as dynamic wrinkles while those that are merely due to aging of the skin are referred to as adynamic wrinkles. Correction: Hyaluronic acid to nasolabial line to hold malar fat pad in place. lower eye area
40-50 years Cheek begins to flatten.  Malar fat pad descent becomes more obvious. Nasolabial lines deepen.  Facial fat atrophy or wasting becomes evident with concavity of the surface contour in the temple area and cheeks appearing. In some individuals the eyes become sunken as a result of fat atrophy rather than forming eyelid bags. Correction: Hyaluronic acid such as Sub-Q, Evolence or Radiesse to central face to hold malar fat pad in place and achieve voluminisation. Fat grafting such as autologous fat transfer. Marionette lines and jowls now appear. Double chin appears. Correction Vaser LipoSelection, SmartLipo or Lipodissolve
50-60 years Menopausal effects. Fat hangs in saggy skin. Nasolabial and marionette lines substantially deepen if not corrected.  Marionette lines and jowls become more obvious. Double chin and ‘turkey neck’ appears. Correction Short scar facelift. MACS facelift. Anterior neck lift. Excess fat appears under eyes Correction Blepharoplasty

COLLAGEN LOSS

Loss of collagen and elastin from the skin of the face. Skin elasticity decreases and the skin become thinner.  Lifestyle choices such as diet and sun exposure have an impact on the rate these factors come into play.  Areas with thin epidermis (eyes and lips) receive wrinkles first.
20-30 years Collagen levels start to fall resulting in crow’s feet and frown lines. Correction: Botox to frown lines and around eye area. Retinol or Vit-C
30-40 years Collagen and elastin levels continue to fall resulting in edge of brow drooping. Extension of nasolabial folds. Lips begin to thin. Glabellar (between the eyebrows) and forehead wrinkles appear. With advanced filling techniques we tend to look at changes that are occurring in the mid face and lower face. Correction: Botox to most of upper face and to elevate eyebrows. Hyaluronic acid such as Restylane, Juvederm or Teosyl to enhance lips and nasolabial lines to hold malar fat pad in place. Sculptra and resurfacing lasers
40-50 years Collagen and elastin levels continue to fall resulting in eyelid bags and lines start to appear in upper and lower lips.  Forehead wrinkles deepen. Gravity and the pull of muscles cause drooping or sagging of the skin and deeper structures from areas of deeper attachment.  Correction: Hyaluronic acid fillers to upper lip. Botox to upper face. Radiofrequency skin tightening treatments such as Polaris, ReFirme and Thermage. Infrared skin tightening such as Titian and LuxIR. Resurfacing skin lasers such as ActiveFx.
50-60 years Menopausal effects. Fat hangs in saggy skin. Nasolabial and marionette lines substantially deepen if not corrected.  Neck wrinkles. More of the eyebrow droops. The nasal tip droops. The lips thin so there is less dry vermillion (pink area where lipstick is applied) showing.  Perioral wrinkles deepen.  Platysmal banding appears in the neck. Correction: Hyaluronic acid fillers to upper lip. Botox of diminishing effect. Face lift, Brow lift, Blepharoplasty or Neck lift often required.
60-70 years Facial skin thins. Skin pigment cells increase in number and size in a blotchy pattern giving rise to brown spots of the back of hand and face (senile lentigo).  Correction: IPL lasers. Skin cancer screening

BONE LOSS

Facial bones lose density and thickness. This causes some minor changes in facial shape. Loss of bone along the bony rim under the eye and in the region of the nose-cheek junction. The remaining upper and lower jaw bones do not change as long as teeth remain intact.
20-30 years Little effect of bone loss seen in this age group. No correction required.
30-40 years Base of nose gets bigger. Some changes seen in chin area. Correction: Enhance facial contours with hyaluronic acid to change nasolabial line to marionette ratio.
40-50 years Chin area continues to enlarge. Eye sockets begin to widen. Correction: Many cosmetic doctors feel the changes are to subtle to require correction.
50-60 years Menopausal effects. Bone density gets less as combination factors such as reduced growth hormone and oestrogen levels occur. Correction: Many cosmetic doctors feel the changes are too subtle to require correction.

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Dr. Patrick Treacy is Medical Director of Ailesbury Clinics Ltd. He is Chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative of the BACD. He is a Medical Advisor to the UK's largest cosmetic website Consulting Rooms.