By Ryan Tsujimura, MD, Plastic and Reconstructive Surgery
As the saying goes, time always wins. However, one can choose to age gracefully or for some, they can choose to fight “Father Time.”
The aging process varies from individual to individual. This has multiple factors; genetics, skin type, sun damage, and exposure to different environmental factors, to name a few.
The end result, is the once youthful upside down triangle shape of the face, slowly becomes more rectangular in shape. The skin loses collagen and elastic properties and begins to show wrinkles and laxity. This produces deepening of the nasal labial folds (laugh lines), marionette lines (lines at the corners of the mouth), jowls, and loose neck skin.
Also with laxity of the skin, fine wrinkles begin to show, especially around the mouth, cheeks and forehead. If this wasn’t enough, the face loses volume, more pronounced around cheeks, eyes, temporal areas. The end result is the rectangular shaped face.
It is important to keep in mind that facial rejuvenation encompasses a huge spectrum of treatments, from the noninvasive to very invasive (surgery). What is indicated will vary from person to person and may be needed at different times. The important fact, is that there is no one treatment for everything. This is the true art and vision, the face needs to be assessed, concerns heard, physical findings taken into account and then using an arsenal of treatments and procedures to produce youthful results.
Common non-invasive modalities are as follows: Botox is used for forehead wrinkles, frown lines and crow’s feet. Today, there is a plethora of “fillers” each with their own properties, and duration of effect, which are used to put volume back into the face and lips. The length of time each filler lasts varies, but ultimately, they have to be replaced. Additionally, there are a multitude of skin peels, superficial laser treatments, ultrasound and radio frequency treatments used to help resurface and tighten the skin. Each of these modalities has its place on the rejuvenation spectrum, but it’s important to remember, the least invasive treatment will have the least and shortest lasting effects.
Some people eventually come to a point that they are ready for more invasive treatments or longer lasting results. Remember, there is no single treatment to address all issues, many of these procedures are used in combination.
When eyebrows droop, it’s usually seen as looking mad or tired. Sometimes the upper eye appears heavy “hooded”. This is not necessarily upper eyelid skin, but the dropping of the eyebrow. This can be corrected by a brow lift. At one time, large incisions were made in the scalp or along the eyebrow border in order to lift the brows. The endoscopic eyebrow lift is now the preferred procedure. Through small incisions in the scalp, behind the hairline, using a camera (endoscope) the eyebrows can be lifted back into position.
If there is excess skin of the upper eyelid or lower eyelid, blepharoplasties can be done. This is performed through incisions in the upper or lower eyelid. A lower lid blepharoplasty can also remove fat (bags) from under the eye. If only excess fat needs to be removed, incisions can be placed inside the eyelid.
For the majority of the face, below the eyes and including the neck, the procedure of choice is a facelift. There are a multitude of variations on the facelift, but the common goal is to lift the deeper structures and tighten and remove excess skin. As the deep tissue moves down, and the support structures become more lax, deepening of the nasal labial folds (laugh lines) and marionette lines (at corners of mouth) become deeper. Jowls form and excess skin in the neck becomes more apparent.
A proper facelift, rejuvenates and lifts the facial structures, it should never look over done or pulled too tight. It shouldn’t make a person look like a different person, it should only “turn back the hands of time.” The result is making a person look more youthful, not like a different person, but a younger version of themselves.
The aging face has many components. It will vary from one person to the next. It is paramount that the face be assessed as a whole, using art and precision, and calling on the different techniques and procedures, the war against time can be fought, and the hands of time turned back.