Facial aging is an inevitable process that happens to everyone. The visible signs of aging are well documented and appear at different rates depending on our unique genetic makeup, which is pre-determined and unchangeable. There are also negative external factors that influence the aging process that are preventable.
Facial Aging affects all the components of the face, which include the skin, fat, muscle and bone. One straightforward way to understand the facial aging process is to be aware of what plastic surgeons critically consider as The 3 D’s:
- Deflation: Loss of facial volume
- Descent: Sagging of the facial tissues
- Deterioration: Texture and color changes of the skin
Deflation refers to the progressive loss of volume in the face over time. The process of deflation can be compared to what happens to a grape as it turns into a raisin. The skin is an envelope that is left with a gradually shrinking support base as the fat, muscle and bone decrease in volume. While all facial structure is affected by atrophy as we age, most volume loss occurs in the subcutaneous fat layer with less loss in the bone, muscle and skin.
- Fat Atrophy: Fat will shrink more than any other facial component. The subcutaneous fat layer that rests directly under the skin shrinks atrophies and becomes thinner as we age. The cheek fat and temporal fat are particularly susceptible to deflation.
- Muscle Atrophy: The muscles of facial expression decrease in size and become thinner as we age, similar to the atrophy of skeletal muscles.
- Bone Resorption: The facial skeleton is also prone to volume loss and becomes progressively thinner with age. This can be particularly pronounced in the upper and lower jaws with the loss of teeth. It is also common around the eyes ( orbits).
Descent refers to the progressive sagging that occurs to the soft tissues of the face as we age. Several factors contribute to the process of descent:
- Increased tissue laxity
- Downward pull of gravity
- Weakening of retaining ligaments
Over time the collagen in the skin and subcutaneous tissues decreases in quantity and quality. As the elastin deteriorates it provides less recoil, causing wrinkles and sagging. Under the influence of gravity, the soft tissues gradually sag to create characteristic features of aging. In addition, the retaining ligaments that attach the facial soft tissues to bony prominences of the face are weakened and less able to hold up the skin and fat compartments.
Deterioration refers to the aging changes in texture and color that occur in the skin. The visible signs of skin deterioration are unmistakable and will significantly impact how old or young we look.
Visible Signs of Skin Deterioration
Dry & Flaky
Invisible or Small Pores
Tight & Unwrinkled
Fine & Coarse Wrinkling
Uniform Color with Few to No Pigmented Spots or Broken Blood Vessels
Dyschromia: Brown Spots, Blemishes, Mottling, Red Spots and Erythema
Dark or Light Hair
Any facial rejuvenation procedure you may consider must address three important components of facial aging and can be thought of in terms of the 3 R’s:
- Revolumization: Treatments directed at restoring facial volume, which include injectable fillers (Juvederm, Radiesse, Sculptra) and fat transfers as well as facial implants.
- Repositioning: Surgical treatment aimed at reversing descent and restoring the youthful position of droopy soft tissues of the face (forehead lift, blepharoplasty, midface lift, face and neck lift).
- Resurfacing Skin: treatments aimed at undoing the deterioration of color and texture that has occurred on the skin surface. A wide variety of treatments are available depending on the degree and type of deterioration such as intense pulsed light photofacials, chemical peels, ablative lasers (C02) and microdermabrasion).