Reversing the Signs of Facial Aging

By Dr. Mitchell Kaye

Advanced Cosmetic Surgery Center of Kentucky

We all recognize the appearance of an older face. In fact, we are biologically designed to quickly scan a person’s face and body to look for clues for health, fitness and age. It is also not a secret that some people age “more gracefully” than others. So why do some people look better as they age than others, and how can we preserve or re-capture some of the beauty of our youth?

Part of the answer to this equation is simply due to luck and good genetics. People with good skin thickness, good facial symmetry and proportions, favorable bone structure and good overall health are at an advantage. Conversely, the long term negative effects of excessive, unprotected sun exposure, poor diet and exercise habits, tobacco use and excessive alcohol consumption are all directly linked to accelerated facial aging and are preventable to a large degree with proper education and effort.

Faces age in a predictable manner. As a Facial Plastic Surgeon, I try to analyze facial aging by breaking the facial structures down to three layers. These are the skin, soft tissue (fat and muscle) and bony skeleton. Each layer can age at a different rate, based on the environmental or genetic factors listed above. We begin to notice these changes as early as our twenties.

The normal aging of skin; i.e. that is not accelerated by environmental effects, will progress in the following manner. Initially the skin will lose some of its color and tone as the blood supply to the skin decreases. The skin thins out due to loss of collagen and connective tissue beneath it. Fine lines with motion will form around the mouth and eyes as the muscles repeatedly contract. These creases occur with facial expression and eventually will become permanent and radiate outwards to the rest of the face to produce deep lines, creases and folds seen in advanced age. The pigment of the skin becomes blotchy and spots and roughness become apparent. Skin growths will then often occur.

Prevention of skin aging due to damage should begin in childhood with proper sunscreen use before exposure. This should also be part of daily skin care for adults, whether or not they are outdoors. Remember that time in a car or near a window allows UV sun damage to occur. Reversal of some of these changes is quite possible. The use of Tretenoin, a prescription medicine, has clearly been shown to increase the thickness of the skin by stimulating collagen re-growth. Irregular pigmentation and spots will respond to Hydroquinone, another prescription medication. The physician directed use of a skin care system, such as the Obagi™, system makes this daily effort easy and effective. Over the counter products, by contrast, are usually moisturizers or tinted to cover up skin problems. They really don’t do much, if anything to correct or prevent t problems. Facial peeling procedures, such as TCA, Jessner’s peel or laser peels, are designed to damage the skin to a certain layer. This allows a new layer of skin to form and will stimulate deeper collagen layers to form. This will produce a tightening of the skin, decrease fine lines and improve skin tone, texture and color. Microdermabrasion does not have this effect since its effects are limited to the outermost layer of the skin, the epidermis.

The next layer, muscle and soft tissue/fat, is critical in understanding facial aging. Loss of fat occurs in a predictable pattern. Around the eyes it produces the tear trough and exaggerates the loosening of the eyelid that produces bags and wrinkling. In the cheeks it produces a sagging and downward and inward movement of the cheeks and jowls towards the mouth. This in turn produces the lines that form between the mouth, chin and cheeks that deepen with age. Repeated muscle contraction also adds to the creation of lines and creases around the eyes, mouth and forehead in particular.

We are all programmed genetically to lose fat in our faces as we age. The biggest change in the practice of Facial Plastic Surgery in my career has been the realization that we can replace this tissue either with fat or with other commercially available fillers, such as Juvederm® XC, Juvederm® Voluma and Sculptra®. I will often use the following analogy with my patients. “What is the difference between a raisin and a grape?” The answer is obviously volume; in this case water. Fat transfers to the face from the abdomen or thighs can provide the patient with a tremendous resource for adding volume back to their faces, if done artistically and properly. Fat transfer can produce a natural smoothing and lifting to the face, using the patients’ own tissues. For a more focused procedure, with little or no down-time, a commercial filler injection can produce a dramatic result in only a few minutes. Some of these results are quite amazing. By now, most people know that Botox® can smooth out surface lines and fine wrinkles. This can be done in such a way as to maintain a natural look, if done skillfully. However, it does not add volume.

As facial aging progresses, there are times when it is necessary to remove excess skin that hangs, smooth out bulges and tighten up looseness. This requires surgery. The use of lasers, radiofrequency and ultrasound devices for tightening have been disappointing so far. Examples of effective surgeries for this purpose include the Face and Neck lift for the mid and lower face, Blepharoplasty for eyelids, Forehead lifts for drooping brows and the use of implants to the chin or cheek to add to the boney structures of the face in cases when they are underdeveloped or deficient. All of these procedures can be performed safely and effectively in an accredited office surgical suite as an outpatient. Incisions are hidden in natural creases and can be extremely difficult to detect once healing is complete.

Based on the logic of progressive facial aging, it is apparent that the combination of skin care, the addition of volume when needed and the tightening and smoothing of facial contours with judicious surgery, if it is necessary, is the most effective way to correct the various stages of facial aging. In fact we almost always recommend skin care, some form of volume restoration in combination with any surgery. Dealing effectively with all three facial layers can make all the difference to the patient. Today we no longer have to accept what nature has in store for our faces. It is now possible to look many years younger than our actual age and maintain a youthful and attractive face for many decades.