Time always passes in forward direction and aging changes are also facts of life. If these changes are known precisely and some how reversed or negated the face maintains it’s natural and younger look. This section we will discuss structural changes in the face due to age in a different section aging changes in the skin are also discussed.
The changes in the facial structure happen mainly due to 2 of the 3 D’s deflations and descent the 3rd D deterioration happens in the skin. These changes could be categorized as follows.
Upper ⅓ of the face
Forehead as we age the forehead starts to hollow in the center from a youthful convex shape it changes to concave this also accentuates the horizontal forehead lines and frown lines. HA fillers could be used to correct this change in addition to botulinum toxin used in combination.
Hollowness in the temples brings the tail of eyebrow down but it also give impression of bony ridge around the eyes with the gap behind making the face wide above temples, then narrow at temples, then wide again at cheeks. Improving this area give lift to the eye brow, makes the side of the face smooth and takes away the peanut head appearance. This area could be improved by a filler placed deep with lifting of the tissues, various kind of fillers could be used like HA filler, collagen generating fillers like Bellafil, Sculptra.
Dark circles around the eye
Please see it as separate section here.
Mid 1/3 Face
This happens due to loss of deep fat pad in the front cheek leading the superficial layer unsupported and gravitating towards the nose in the mid face, marionette lines and jowls in the lower face. Filler placed deep in the front cheek lift fill the triangular hollow in the front cheek this is different from the side cheek lifting with filler in the cheek bone.
Nasolabial folds NLF
The improvement in the fold starts after filling the deep front cheek, the next step that helps is a deep filler placed in the side of the nose helps in lifting this area in comparison to the fold, the filler is also placed superficially to smoothen this area. Finally if there is a deep crease due to long time of having this fold can be improved by filling the crease very superficially.
Hollow under the cheeks bones and in front of the ears.
This is not just aging sign but also common people who workout lower mid face is small, sunken appearance with suckling movements, lower volume in the front of the ears contributes significantly to the marionette lies. The areas are generally filled with collagen generating filler like sculptra or HA filler like Restylane
Lower 1/3 Face
Down turning corner of the mouth Very common problem and the most contributing factor is lack of deep support that is loss of bone, loss of deep in above areas, excessive skin. The less contributing factor is done ward pull from the muscles.
This section is discussed separately.
This happens due to sagging superficial soft tissue from the full face and lack of deep support in the upper and lower face cause these line improvement need correction of the deep support in upper face in front and side cheeks, filling up space in front of the ears, masking that is filling the triangular area in front of the fold. Lastly barbed PDO threads and lift to some extent.
Wide flat chin
As a person ages the chin becomes soft, flat, thin along with the shrinking of the bone, wide with wrinkles and dimpling. Receding chin will also contribute to prejowl sulcus and irregularities in the jawline. Deep grove between the lip and chin can give appearence of the witches chin. The changes in the chin are realized and can be corrected by appropriate volumization for projection and crease between the lip and chin. Chin enhancement could be done with HA fillers like restylane/juvederm, and collagen generating filler like Bellafil.
Weak jawline, jowls, prejowl sulcus.
This happens due to lack of volume in front of the ears, low overall volume in mid face, weight gain and gaining fat in the superficial layer, reduction in the volume of jaw bone. This is enhanced first by improving chin projection then filling in lost volume in midface and then with filler done in prejowl sulcus and behind the jowl. Jawline could be enhanced with HA filler like Restylane Lyft, Sculptra, Radiesse and Bellafill.