Facial aging is a complex, integrated and dynamic process involving multiple levels of the facial anatomy including the bone, soft tissue and the skin. It is a interrelated process where the aging of one layer can lead to a domino effect on the adjacent layers. The aging process starts as early as in the 30s and progresses with chronological age.
Bone:
Bone resorption and recession with chronological age reduces the support for overlying fat pads and muscles, causing a shift of the soft tissue downwards and medially with gravity. This leads to hollowing of the cheeks, deepening of the nasolabial fold, prominence of the lower eyelid-cheek junction as well as imbalance in the upper, middle and lower face proportions.
Fat:
The fat compartments on the face comprise of superficial and deep fat pads. In aging, the deep fat pads undergo atrophy while the superficial fat pads tend to be resistant to atrophy. This results in loss of deep support for the overlying superficial fat pads and soft tissue, resulting in displacement of the soft tissue structures downwards and medially with gravity.
Muscle:
Facial muscle hyperactivity and repeated muscle contraction related to facial expression lead to the formation of dynamic wrinkles and lines. These are most commonly observed in the forehead, glabella as well as around the eyes. If left untreated, these dynamic lines can progress with repeated creasing and become permanent or static lines.
Skin:
Skin aging is a combined result of intrinsic and extrinsic causes.
Intrinsic skin aging is related to chronological age and manifests as a result of loss and degradation of the elastin-collagen fiber network as well as degradation of glycosaminoglycans in the extracellular matrix.
Extrinsic factors such as ultraviolet exposure and cigarette smoking futher accelerate this degradation process. Increased production of metalloproteinase and reactive oxygen species activity with UV exposure and smoking directly contribute to breakdown of the components of the extracellular matrix.
Visible changes related to skin aging include hyperpigmentation, wrinkles, rough texture and dryness, telangiectasia and a yellowish/sallow skin appearance.
Therapy:
In order to arrest and reverse the above aging process and produce holistic, visible and appreciable results, we have to target all affected layers of the facial anatomy where the aging process has taken place.
Bone resorption can be treated with deep injection of high viscosity and stiffness fillers.
Fat loss can be restored by volumizing with injectable fillers and fat pads can be repositioned by performing threadlifts.
Muscle overactivity and dynamic expression lines can be treated with injectable botulinum toxin (Botox).
Skin aging can be delayed and reversed with a combination of judicious use of skincare and topical medication, lasers and heat based devices such as HIFU and radiofrequency as well as superficial injectable techniques such as skinboosters and mesobotox.