Many people come to me for rejuvenation of their face. Clients like to come in and tell me that they need a facelift but that they do not want to look done. During the conversation I always start by asking the patient what areas of their face bother them the most. Many people will simply take their hands and move their jowls and neck in a uniform motion towards the back of their neck or up past their ears. Many patients will also pull their face so tight during this maneuver that all wrinkles and irregularities are immediately removed from their face. At this point in the consultation I start my discussion with the patient regarding what makes a face attractive and youthful and why. Most of my patients are under the assumption that the only thing that has actually changed in their face is that over time their skin has become lax and that is why they feel that they look tired and older. Although excess skin and skin laxity play a major role in facial aging, there are other issues that are equally important and to provide the patient with the best possible outcome each of these areas needs to be addressed.
I feel that there are really three issues of an aging face that needs to be addressed in order to effectively rejuvenate the face. These categories can be broken down into several sub categories and we will touch on these issues in future discussions, but for now, let’s just use this time as an introduction. The first issue that I discuss with my patients is the quality of their skin. I feel strongly that beautiful skin is an extremely attractive trait. Perhaps more than a face that has no areas of skin laxity, I believe that a face with smooth and even toned skin is a very attractive characteristic. The quality of the skin will need to be addressed in a non-surgical manner for the most part. A good regimen of skin care with routine microdermabrasions and chemical peels is a start. Home care cosmeceuticals and sun screen are essential to maintaining good skin quality. If the quality of the skin has significantly more damage, then more invasive procedures such as deeper chemical peels, Fraxel laser, or CO2 lasers may be necessary.
The second area of the face that which I feel also contributes to aging is the decrease in volume of the face. Many patients will complain that even when they lose weight, they look even older and more tired. Conversely, when they gain weight, the appearance of their face does not change much. The youthful face consists of a great deal of volume. I don’t mean to say that a youthful face is cherubic, and each face has its own ideal volume. The youthful face has more of a heart shaped appearance and as we age our face becomes a bit more oval in shape with the loss of facial volume. Everybody looses volume in their face as they age and that volume can be variable. One individual may loose almost no volume but they start out so thin in the face that even that small amount shows quite dramatically. Other people with heavier faces may not show volume loss until they have lost a great deal more. The volume I refer to is fat. Wonderful studies have been done on cadavers of the face. There are actually several distinct compartments in the face where fat exists. If each compartment looses even just a little volume of fat, then the sum total of fat loss can be quite dramatic. So with all of that said, one of the areas of the aging face that I feel need to be brought into the facial rejuvenation conversation is the need to revolumize the face. I use a great deal of fat injections to the face for this purpose, however, I have a busy office practice and use a great deal of well-placed fillers to accomplish the same goal.
So, if we have taken care of the quality of the skin and the volume of the face, what is left to do to the face in order to rejuvenate an aging face. The answer is skin excess. Excess skin is the reason that most patients seek facial rejuvenation procedures. Improving the quality of the skin and increasing the volume of the face are essential to helping with the appearance of the aging face, but, removal and repositioning of excess skin, muscle, and fat in the fat is what will give the most dramatic improvement to the aging face when performed correctly. There are a number of non-invasive techniques that have been introduced to the market that tighten and elevate skin. Many of these work very effectively and are great for the younger patient who desires some skin tightening, or the older patient who simply is not ready nor cannot afford the downtime associated with a surgical procedure. Having said that, there simply is no substitute for a facelift when performed on the right patient. There are many different types of facelifts, including less invasive, or "mini" facelifts. It is up to your surgeon and you to discuss which procedure will work best for you. The goal of all facial rejuvenation surgery is to create a naturally appearing face avoiding the wind swept and over tightened face that patients have seen all too often and likely the reason many people avoid facelift surgery.
I will focus on the specifics and alternatives I introduced in each of these discussions in the future. The take away message for now is that for effective facial rejuvenation the areas that issues that need to be addressed are skin quality, facial volume, and skin and soft tissue excess and position.