Understanding Facial Aging

by Lawrence Janowski, MD

In order to understand how to best achieve facial rejuvenation, one should have a fundamental understanding of what causes the face to age in the first place. The most important principle I can stress is that the majority of the aging of the face comes from a loss of facial volume. Our faces are literally shrinking! There are several components to this

• Our skin itself is losing its natural collagen and elastin, starting in our thirties. This means our skin is getting thinner, less elastic and less smooth. It just doesn’t “snap back” into place anymore, but begins to sag.
• Our natural fat compartments under the skin begin to reduce. This is most noticeable in the cheek area, but other important areas are the temples and the area just below the cheek in front of the ear.
• Over time, our bone begins to resorb in the face, resulting in a widening of the eye socket, a retraction of the area over the upper lip (which increases lines and wrinkles there as much as smoking or lip pursing), shrinking of the jawbone, and a retraction of the natural bony ridge that supports the eyebrow.
• Our facial muscles can atrophy and shrink as well. As a result of the loss of all of this structural support, the skin sags, and jowls appear. In addition, our naso-labial fold (the fold between the corner of the nose and the corner of the mouth) deepens, as tissues fall toward the center of the face.
• Our mouth corners begin to turn down as they lose support as well.

And now, the good news…

Virtually all of these changes can be reversed. By this I mean, we cannot restore bone or fat to the face (with the exception of surgical fat transfer), but the effect of fillers, particularly collagen-stimulating fillers, can very naturally recreate these structures. Fillers can both volumize and lift. You might be asking yourself “maybe I should just get a facelift and be done with it!” which would be a reasonable thing to ask. But remember, although a surgical facelift will do an excellent job of removing and lifting excess loose skin, it does not add one drop of volume back to the face. In fact, after pulling all that skin back and cutting it away, a facelift could actually accentuate the appearance of volume loss. I’m sure we have all seen someone who looked a bit too “pulled back”. Even with a facelift, volume correction is necessary. Fortunately, with the fillers we have at our disposal that can last up to 5 years and can regenerate lost collagen, natural, long-lasting, non-surgical facial rejuvenation is not only possible, but even more desirable than surgery.

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