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Facial Aging

Dr Abdul Hameed
Oral and maxillofacial cosmetic surgeon

There is no specific age when the signs of aging begin to appear and there are many factors that enter into the gradual process of aging. Many people become aware of the changes over a short period. It seems as if things were “holding up” well until the aging suddenly began. No one can predict when an individual’s rapid ag­ing period begins or the rate at which aging continues through life because we each age differently.

The appearance of the face and neck typically changes with age. Facial aging process begins with surface and subsurface structural changes in multiple facial tissue layers, including skin, fat, muscle, bone and teeth. Facial tissue ages interdependently, contributing to the overall facial appearance of the face. Changes in one tissue layer have an effect on the other layers. As we grow older, the skull decreases in size, some of our fat layer is absorbed, and degenerative changes in the skin causes it to lose much of its elasticity; resulting in the development of wrinkles. In addition, the muscles lose their tone and portions of the face “deflate” and lose volume. As the deterioration continues, the skin begins to sag and droop, and the lines of facial ex­pression become deeper and more apparent (forehead lines, grooves at the side of the mouth, etc.).

Skin - With age, skin undergoes several changes. Changes include Skin more likely to wrinkle or sag because of loss of underlying fat and attachment:

  • Reduction in collagen
  • Thinner skin
  • Drier skin
  • Less elastic skin
  • The skin around the eyes gets wrinkles, creating crow's feet; at the side of the eyes.
  • The number and size of blotches and dark spots on the face increase.
  • Eyebrows and eyelashes turn gray.

Collagen - Collagen loss is a key factor in the aging process. As skin ages, the middle layer of skin (dermis) thins due to collagen loss. This reduces the skin’s ability to retain elasticity (from elastin) and moisture (from hyaluronic acid). Due to this loss of elastin and hyaluronic acid, the skin becomes:

  • Dryer
  • Less elastic
  • Less supple
  • Thinner (volume loss)

Fat - A youthful look depends on having the right amount of facial fat in the right places. Redistribution, accumulation, and atrophy of fat lead to facial volume loss:

  • Areas lose fat. Examples are the forehead and cheeks.
  • Areas that gain fat. Examples are the mouth and jaw.
  • Modification of the fat pads leads to contour deficiencies.

In addition, the areas of fat tend to become farther apart. Instead of a smooth, almost continuous layer, the fat pads appear as separate structures.

Bone - There is a significant loss of facial bone with age. Aging of the raniofacial skeleton may be due to changes in the relative dynamics of bone expansion and bone resorption. Bone resorption leads to biometric volume loss. Without the structural support of bone, there are noticeable changes in the other layers of overlying soft tissue and skin.

Dentition - Missing teeth and receding gums change the appearance of the mouth so your lips may look shrunken. Loss of bone mass in the jaw reduces the size of the lower face and makes your forehead, nose, and mouth more pronounced. Your nose may also lengthen slightly.

Procedure Options - Classified in three categories:

  • Resurfacing - Resurfacing techniques are used to modify the surface of the skin. They correct the effects of photo aging, including fine lines, irregular pigmentation and blemishes. Common resurfacing techniques include:
    • Chemical Peels
    • Microdermabrasion - Microdermabrasion is a non-surgical technique that improves the texture and appearance of the facial skin. A controlled spray of crystals reduces the outer layer of dead skin cells, stimulating skin regenera­tion.
    • Laser resurfacing etc.
  • Injectables - Injectables include a broad range of substances which are within the tissue. Their main usage is for the treatment of lines, wrinkles and folds, as well as to restore the volume loss. Three of the most common types include:
    • Neurotoxins - Botulinum toxin is used to weaken muscles and minimize dynamic lines.
    • Dermal fillers - Wrinkles and depressions of the face can be softened and diminished through the injection of medical grade tissue fillers. The smile lines, lip borders, frown lines, forehead lines, crow’s feet, and facial scars can be improved through the use of selected products.
    • Collagen stimulators - Collagen stimulators are injected into the dermis or subcutaneous layer, filling in the places where collagen has been lost. These stimulators induce new collagen. The newly-produced collagen provides a structural framework to hold hyaluronic acid and elastin and helps restore the dermis. Hyaluronic acid attracts water molecules to the dermis and restores skin moisture. Elastin provides elasticity and helps the skin stretch.
  • Surgery - Surgery includes a wide range of procedures from lifts to liposuction to fat transfer. Three of the most popular surgeries are:
    • Liposuction
    • Fat transfer
    • Facelift - The facelift proce­dure is designed to reduce sagging caused by loose skin and drooping, fatty tissues of the face and upper neck. The operation is done to treat the relatively early signs of ag­ing or to improve the advanced signs in old­er patients. If the sagging is significant, the results of surgery may be more dramatic. In younger patients, the results may be more subtle; they may simply “look less tired”.