About Facial Ageing
A face that has aged gracefully is one of the most attractive sights in our world. The trinity of physical attractiveness, good health and learned wisdom through experience is revered in all societies and cultures.
But what is ageing gracefully? Historically it has been used pejoratively against those that surgically reverse the signs of ageing. In reality, as today’s medical and dietary advances prolong life expectancy, todays 50 year old has lives and feels like yesterdays 30 year old, but human biology hasn’t kept up with society. Ageing gracefully is simply looking the way that we feel, and cosmetic interventions enable that where nothing else can.
How Faces Age
Along with inner wisdom, experience and knowledge come outward facial changes.
The face which, having been exposed daily to sunshine, positioned further from gravity and constantly lit from above, distinguishes our age like no other body part.
I summarise the visible effects of facial ageing as the four D’s:
Descent
- Deeper tissue folds form caused by continuous muscle tone and movement against gravity
- Facial fascial compartments weaken and fat within sags towards the lower facial third creating jowls, loss of jawline and neck definition.
- Weakening of the upper eyelid muscle leads to hooding and excess skin
- Loss of mid face fascial support leads to rounded hollowed undereyes
- Weakened orbital support creates bulging eyebags
- The upper lip length elongates reducing cupids bow definition and upper teeth show
Deflation
- Bony changes cause reduced bone volume in the midface, temples and jawline
- Deeper facial fat pad volume descreases in the midface, temples, and brow
- Overall skin volume and thickness reduces
Deterioration
- Foreheads lengthen as hairlines recede
- Skin thins, develops fine lines and wrinkles and becomes excessive
- Exposure causes reduced skin strength, pigmentation, pores and dehydration
Development
- Ears and nose get longer as cartilage grows
- Fat grows and organises in lower third jowls and under chin
- Excessive skin muscle and fascia develops in lower facial third and neck
Descent
If there is skin excess it needs to be removed. If there is soft tissue sagging or descent, it needs to be lifted back to it’s original position. In my opinion, the only predictable and natural way to lift descended and excessive soft tissue is face and neck lift surgery.
I am yet to meet a patient who has had a threadlift who would have another and the results from skin tightening machines are equivocal at best. A common error is trying to inflate out descended facial ageing which leads to the caricature overfilled filler look – Isaac Newton would disagree that adding volume (read weight) to anything creates lift!
Deflation
Much like fillers won’t sympathetically improve a descent issue, a face which has lost significant volume will need extra volume to restore youthful attractiveness.
Trying to lift out a deflationary issue creates the tight faces of yesteryear. Volume can be resited from the lower face to a degree, but if bony, orbital or deep fat deflation is significant this needs to be replaced with injectable fillers, fat transfer or implants.
Deterioration
As we age our skin becomes lazy. In youth our skin turns over in a regular cycle shedding old skin for new so that visible skin is fresh, hydrated and smooth. As we age, the skin cycle lengthens exposing skin to UV light, free radicals and the elements for longer.
Pores widen to hydrate the older drier skin, fine lines and wrinkles develop and pigmentation is produced. The only way to improve skin is to remove the old with peels or laser and speed up the cycle again which can only be achieved with prescription topicals.
Development
Fat grows and organises within the jowl and deep neck, there are several non surgical modalities that claim to reduce neck and jowl fat but all of these target the superficial fat only.
This is fat we need for a smooth supple neck and jawline and excessive removal of superficial fat leads to contour irregularity with no change in structural shape. Fat deep in the neck needs to be addressed surgically, leaving the superficial fat to maintain superficial volume.
Multilayered Approach
The days of choosing one approach or another are gone. The ideal result needs a multi-modality targeted approach. Facelift surgery will address descent and a little mid face deflation but volume deflation elsewhere will need volume augmentation.
Likewise we are increasingly consulting patients with filler fatigue, being offered more and more volume by their practitioner but not seeing the suggested results. In our practice we offer everything from prevention advice through prescription skin care and treatments to non-surgical injectables, laser and rejuvenation surgery which means we can tailor the right plan to you. We recognise that expertise is borne of experience and a focussed skillset which is why Dominic and Rebecca share the care of all our patients.
Prevention
Weight Control
We really are what we eat. A good diet full of antioxidants and alkalinising foods will improve skin health and fascial structure and delay the changes of ageing.
Food intolerances and allergies are increasingly common and manifest as poor skin health. Regular weight gain and loss with dieting and bingeing will lead to excess skin and muscle and deeper fat accumulation.
Vitamin D
Most of us today are Vitamin D deplete. Essential for good bone and skin health, supplements are available in every chemist and are much better than sunbeds!
HRT
As the menopause starts, Oestrogen drive is reduced and skin thickness reduces 10% a year over 3 years leading to a rapid escalation in facial ageing. Daily replacement therapy and/or creams and gels can really slow down skin thinning.
Smoking and Sun Exposure
Both of these are evil when it comes to facial ageing. Free radicals and UV light physically break down skin strength and structure leaving little defence against gravity and exposure
Hydration
For good skin health and perfusion we need to be well hydrated – from inside not from external moisturisers.
Skin Care
We need our skin to be actively turning over to remain clear and bright. Prescription topical lotions specifically address the causes and effect of facial skin ageing.
