By understanding how the face ages, it is easier to choose the best treatments for rejuvenation. There are three fundamental processes that occur in facial aging:
1. volumetric change
2. skin damage
3. dynamic wrinkling
Volumetric Changes with Age
Volumetric change refers to changes in the overall fullness of our face. The underlying support provided by our skull and the fat in our face are primarily responsible for the fullness of our face. It may be surprising to learn that as we get older, both the shape of our skull changes and the fat on our face redistributes. When we are young, our face tends to be full, and, in women especially, it has somewhat of a heart shape.
Aging of the skull is mostly characterized by loss of the cheekbones and loss of bone around the eye sockets. Changes in fat are most obvious from loss of volume in the cheeks, under eye hollows, and temples. Other areas are affected too, such as the forehead and lip.
Loss of tissue in these areas means there is less to support the overlying skin and it sags, bunches, and folds.
Some areas, however, gain fat instead of lose it. This is most evident under the chin. Fortunately, this area can often be treated very nicely with liposuction of the chin and neck.
Skin Damage and Aging
As we age, our skin becomes weaker making it more likely to sag, bunch, and fold. Although our skin weakens with time naturally, the primary cause of skin damage is ultraviolet radiation from the sun or tanning beds.
The number one thing you can do to slow aging of your skin is to protect it from the sun and to never use tanning beds. That cannot be overemphasized. Retinoids, antioxidants, and growth factors can also help, but they will do little unless you protect your skin from the damaging rays of the sun and tanning beds.
Some people claim that tanning beds are safe, but this is not true. Tanning beds have been proven to damage the skin and cause cancer. If you want color, a spray tan is safe for your skin.
It is impossible to completely reverse all damage that has been done, but there are many procedures to help minimize signs of skin damage including photorejuvenation, laser resurfacing, and chemical peels.
Wrinkling and Aging
The last of our 3 fundamentals of aging is dynamic wrinkling. Repeated skin movements can lead to signs of aging. Similar to the old saying by our moms, “If you keep making that face, it will get stuck that way”, if you repeat a movement that results in a wrinkle enough times, you could end up with a more permanent wrinkle there.
The most common areas to see this are on the forehead, in the frown, and around the eyes as crows feet. It makes sense, then, to reduce movement in these areas. The primary way to do this is with Botox or Dysport, and Xeomin.
Even if wrinkles are already present, I have seen them lessen and even disappear with consistent and repeated Botox treatments over time.
A less talked about, but also important, cause of dynamic wrinkling is wrinkling caused by sleeping. At least one study has shown that repeatedly sleeping in a a position that bunches your skin can cause wrinkles.
Knowing the 3 fundamentals of facial aging (volumetric changes, skin damage mostly by ultraviolet radiation, and dynamic wrinkling) lays a framework to help us understand what happens as we get older. Having this foundation makes it easier to see how the treatments we have available can help prevent and reverse some of the signs aging. It may also help explain the limitations of some of our treatments.