WHAT IS FACIAL AGING?
Changes in our facial appearance over time are due to two main factors: gravity’s effect on the soft tissue of our face, which both stretches out our face and causes it to droop, and changes in the quality of the surface or skin such as fine lines and hyperpigmentation.
The soft tissues constituting the face are in layers, with the skin on the surface, then a layer consisting of fat, mixed with a layer of connective tissue, and then the SMAS layer (subcutaneous musculoaponeurotic system). The SMAS layer of the face, a strong fibrous sheet of tissue, separates the deeper facial structures such as facial movement muscles, nerves, and other structures that are not as affected by aging as the soft tissue.
The anatomy of youth can be understood using some basic analogies. Your ‘look” is created by your “frame,” the same way the frame of a couch creates the “look” of a couch. The research I have conducted and published shows that your “frame” doesn’t change (until extremes of aging) and explains why using the proper techniques, at the right time, can duplicate your past appearance the same way reupholstering an older couch can restore the couch as new since the frame did not change.
Our frame is fitted with a “garment.” Imagine a quilted comforter that fits our frame like a glove when we are a mature yet youthful adult at our best. So, our 35-year-old appearance is essentially our frame that creates our look, our attractiveness, our uniqueness, and our individuality and is fitted perfectly by a thick garment, allowing everyone to see our unique frame.
While our frame stays similar most of the time, the garment that originally fits it like a glove does not. If we look at the garment separately, it has the same biomechanical behavior as pizza dough. If pizza dough is held in the air, over time, it will predictably stretch and descend toward the ground. Stretched out pizza dough and an aged face have similar principles.
Thus, youth is like wearing a perfectly fitted pair of pants, the garment, on our lower body, our frame. Aging is essentially the pants getting bigger and bigger as time progresses.
As we age, all these facial layers begin to sag due to gravity’s effects. The fat pads in our cheeks slide downward, our cheeks become hollow, and we develop jowls, creases, and eventually a loose neck.
Changes to our facial shape, from a tapered shape with a defined jawline, when we are young, to a square, elongated shape with folds and laxity as we age are the major signs of gravity’s effects.
The specific ‘look’ that reflects each decade of our lives (what makes a fifty-year-old look fifty, a sixty-year-old look sixty, etc) is predominately created by our gravity changes, with drooping of the neck and jowls, as one of the last gravity changes that occur. Even before we look old, gravity affects our face and creates illusions of tiredness (bags under our eyes), sadness (a down-turned mouth), and anger (furrows between our eyes).
Since all the facial tissue layers are affected by gravity, only procedures that reposition all the drooping tissue layers effectively reverse our aging facial changes. No significant or long-term result can be achieved without utilizing procedures that are directed at reversing our facial gravity changes.
A facelift, known as a rhytidectomy in medical terms, is a procedure in which the loose skin on the cheeks and neck, along with the underlying, sagging facial soft tissue, is lifted, tightened, and repositioned. A facelift is not just one procedure; different techniques have evolved that produce different results from past techniques. The deep-plane facelift today produces incredibly natural and longer-lasting results than older skin-only procedures. Often a facelift is combined with other cosmetic surgery procedures such as a brow or eye lift that offers a balanced, complete, and more natural facial rejuvenation.
The type and degree of facial rejuvenation should match the degree or stage of aging changes. Since today’s procedures can always appear natural, a person does not have to wait to look bad to return to their optimal stage of appearance. When approached earlier, facial rejuvenation will produce a subtle refreshing of our look. Similarly, if a person has significant aging changes throughout their face choosing substandard techniques or having isolated procedures will either be correct or create an imbalanced result. Under corrections of aging changes and/or imbalances between areas of the face are some of the most common reasons people seek revision facelifts.
Should I Do It Now or Wait?
This is a common question, but the way we think it out today differs from the past.
- Once you notice your aging changes, you will not “unnotice “them.
- As aging changes advance, minimally invasive procedures have less effect, have a long-term recurring expense, do not eliminate the need for surgery, and when overused, look obvious and can have complications.
- Current techniques such as Deep-Plane facelifting and Vertical Galeal Advancements are natural and undetectable, eliminating the past reason to wait because surgery created an unnatural look.
- Certain aging changes such as festoons, facial creases, or neck rings can become irreversible if not corrected earlier. Waiting can only limit the potential result.
- The earlier aging changes are reversed, the better the result and the longer it lasts. Minimally invasive techniques camouflage aging changes rather than reverse them.
Rhinoplasty, nose reshaping, is a general term used to describe procedures that change the appearance of the nose. Although most commonly used for cosmetic reasons, functional nasal issues such as difficulty breathing can often also be addressed. Current rhinoplasty is very different from the past when procedures were often very obvious. Today, rhinoplasty experts have otolaryngology training (ear, nose, and throat) in addition to fellowships in facial plastic and reconstructive surgery (double board-certified) and can offer much more advanced techniques. Not only are natural, predictable results the rule, but recovery is quicker both cosmetically and functionally.
Your surgeon’s philosophy is important. “If it looks like you had it, it’s not worth having”. Noses can be smaller, but do not have to be small to be beautiful and enhance one’s facial appearance. But philosophy alone cannot overcome the training and ability of a particular surgeon. Overall, our nose should not be noticed when someone views our face. The majority of one’s beauty is centered on their eyes, cheekbones, and facial contour; our nose should fit our face, have aesthetically pleasing angles, and most often go unnoticed on our face. Often great rhinoplasty causes the effect of bringing an observer’s gaze to our eyes and not our nose. Comments on the beauty of your eyes are often the most significant compliment in sophisticated rhinoplasty.
Noses are individualized procedures that are designed based on the specific imperfections in the nose as well as the degree of the nasal imperfection. This is then balanced with how the nose fits into the overall aesthetic of the face. One nose may look fine on one face and not another. A rhinoplasty specialist can be predictive, before any commitment to a procedure, of the degree of outcome that can be achieved, while still maintaining a natural, un-operated upon appearance.
Since the majority of people are motivated by their lower face or neck and aging is due to vertical stretching out of the face, vertical repositioning of the soft –tissue using the underbelly layer effectively reverses these aging changes. If only the lower face is approached then the repositioned soft tissue would bunch or pleat around the sides of the eyes. This can only be avoided by changing the vector of repositioning from vertical to sideways or backward, the problem is that if we drop an object it doesn’t go sideways or backward, it goes vertically down.
The goal of treating the forehead is not about raising the eyebrows, normal forehead muscle action keeps most eyebrow complexes in a relatively normal position. The goals are to create the same soft-tissue tone in the upper face as in the lower face, make the transition from the lower face smooth, allowing full vertical repositioning of the lower face, and open up and frame the eyes.