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Facial Aging

HOW WE AGE

Concepts of facial aging are in evolution. It was formerly thought that all facial aging changes are due to stretching out and sagging of skin, and so the treatment was surgery to pull and tighten skin of the cheeks, eyelids, and forehead. But anyone who has seen plastic surgery patients in the past can recognize the telltale signs of tight skin and cheeks looking pulled and distorted.

Current thinking is that skin stretching is only part of the aging process. The fatty tissues of the face sag, and perhaps some of the fat wastes away. The aging face develops lines between the corner of the nose and the corner of the mouth ("smile lines," or "nasolabial folds"), when the loose cheeks drape across the more tightly attached skin of the lip regions. This commonly happens after age 35-40, but it can happen earlier or later in different families.

At a later age, jowls form as the cheek tissue falls down from the cheekbones and central cheeks and gathers in the lower cheeks and over the jawline. "Marionette lines" develop between the corners of the mouth and the lower jawline as the jowls settle across them. So the cheekbone region loses its "projection," and the smooth line of the jaw becomes hidden behind the sagging fat, causing the lower face to develop a wider, heavier, or "square-jawed" look.

The lower eyelids begin to look puffy in most people in the later 30's and early 40's, although in some families this look can develop by age 20 or so. This was formerly thought to be due strictly to bulging of the lower lid fat, but now it seems that most or perhaps all of this lower lid fat is of normal amount and that the appearance of puffiness is due to the falling away of the upper cheek fat from the junction of eyelid and cheek. As this fat drapes lower on the face, the fat trapped in the lower eyelids looms large by comparison with the now-hollow upper cheeks immediately below them.

The upper eyelids also develop a puffy look with aging. Typical plastic surgical treatment in the past would have been to cut away not only excess skin but also all of the "bulging" upper eyelid fat. Although some people like the resulting look, many patients ended up with a deep-set look of the eyes that they never had when they were young. Evolving concepts of upper lid beauty and aging suggest that a good surgical treatment for many is to trim excess skin but to leave most of the fat. The fat at the inner end of the upper lid is the most likely to still be removed.

In recent years the aging forehead and brow region has sometimes been overly pulled and elevated by surgery, putting many eyebrows higher than is natural. Current trends are to produce less elevation of the eyebrows and mostly at the outer ends.

Different people prefer different looks, and the treatment you get should reflect this. There are new ways to treat some appearance changes due to aging, but some of the treatments of the past are still valuable. There are many surgical (and non-surgical) treatment options available today. At the time of office consultation you should discuss with Dr. Cedars what your preferences are. He will examine you and make recommendations for treatment that best suit your likes and needs.

3300 Webster Street 1106
Oakland, CA 94069