Why do our faces age? And what can we do about it!

Anand D. Patel, MD
Article by
Austin Facial Plastic Surgeon

Getting older would be much more enjoyable if we didn’t have to look older as well. Many of us feel younger on the inside than how we look on the outside, and that can be tough to deal with. To make matters worse, our society tends to associate beauty and youth with value and success. This is especially true, when it comes to our faces. So it’s no surprise that many of us are constantly looking out for that miracle product or service that will turn back the clock.

But why does it happen? How does aging cause wrinkling, deep lines, droopy skin, and a sunken look? One way to look at it is to group facial aging as either changing tissue quality or quantity. Tissue quality refers to the character of the skin (e.g. dryness, texture, wrinkling, age spots, prominent blood vessels, and benign or precancerous lumps and bumps). Tissue quantity refers to laxity, such as the type that leads to a droopy neck and jowls, and also volume loss. Some areas like the central face, cheeks, and lips seem to deflate, while others like under the chin keep expanding. Altogether, changes in tissue quality and quantity lead to the telltale signs of facial aging – but the treatment of both are very different.

During our youth, collagen and elastin provide volume and tightness to our skin. These helpful proteins are constantly produced and broken down in the body. With aging, however, the seesaw tips from production to breakdown, and we lose volume and gain laxity. How and why this happens is still being worked out, but various enzymes, proteins, and free oxygen radicals are thought to contribute. It appears that our cells are genetically programmed to shut down after a time, but also environmental exposures tend to accelerate the process. The body protects itself from aging by producing DNA repair proteins, enzyme inhibitors, and antioxidants, but they decline over time.

Why some people age faster than others is probably influenced by both their genes and their environment. Genetic factors may be the most important, so if your parents looked good as they aged, there’s a good chance you will too. However, this can be countered by lifetime exposure to ultraviolet radiation from the sun (UV). The two main types of UV, A and B, create ongoing inflammation which not only accelerates normal aging, but also causes a hardened, leathery quality to the skin. Darker skin pigmentation protects against solar radiation, but not totally. Other environmental factors that are thought to accelerate aging include an unhealthy diet, alcohol use, smoking and nicotine, pollution, poor overall health, and stress – just look at the past few U.S. Presidents.

The key is prevention, and you’re never too young or too old to start. Have you ever noticed that those with a healthy, stress-free lifestyle tend to look healthier. It seems the adage “garbage in, garbage out” also applies to aging. That means good nutrition, regular exercise, good skin care, and staying away from smoking, nicotine, and other environmental toxins. It’s not possible to entirely avoid the sun, so a daily sunscreen with the appropriate strength (SPF 30) becomes critical. Make sure that your sunscreen protects against both UV-A and UV-B, because some do not. In a world where the effectiveness of many products is ill-supported by hard data, Tretinoin (e.g. Retin-A), a form of topical Vitamin A, is one that has good evidence for working well to reverse sun damage. Ask your dermatologist if you are a good candidate.

For those of us beyond the point of prevention, there are good treatments to turn back time. Botulinum toxin (e.g. Botox) was originally used in high doses to treat muscles spasms, but has gained widespread success in much smaller doses to relax facial muscles and soften deep facial lines. It is particularly good for deep forehead creases, the “elevens” between the eyes, and the “crow’s feet” on the sides of the eyes. Botulinum works by disrupting communication from the brain to the facial muscles. There is an art to these injections and one can achieve a “relaxed” look without the unnatural, frozen look. It takes days to weeks before the injections take effect and they last about three months. Most importantly, cosmetic botulinum use has proved to be safe over the decades.

Soft tissue fillers are injected products that are used to plump up areas under the skin that lack volume. Some are even thought to stimulate the body to produce more collagen. Fillers have been used in many parts of the face but the most common are the smile lines, marionette lines, cheeks, and lips. These days, the most common types include collagen, hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid. The various fillers may differ in the area or depth they are injected and how long they last. Most fillers can last anywhere from 6 to 15 months. Generally, they go away faster in areas that have more motion (e.g. around the mouth).

For fine, etched lines that do not go away with stretching of the skin or after botulinum treatment, a skin resurfacing procedure can give an amazing result. Skin resurfacing removes the top layers of skin and allows new baby skin to take its place. The deeper one resurfaces, the better the result, but the longer the downtime. Skin resurfacing can also be helpful for age spots and even precancerous lesions. Generally, there are three types of resurfacing: dermabrasion, chemical peels, and laser. The term “laser” can sometimes create more hype than anything else, but in the world of resurfacing it has been truly revolutionary by providing a more precise and accurate treatment.

For patients who have significant skin laxity or volume loss, the gold standard is still surgery. The goal is to restore, not transform, one’s appearance. The artistry lies in the ability to hide incisions well and create symmetry. Upper and lower eyelid procedures remove excess, wrinkled skin and bags to give a more refreshed look. A brow lift can also tighten the skin in the upper eyelid and at the same time relax the forehead lines and crows feet. A face and neck lift raises the jowl to enhance fullness of the cheeks and restores definition to the jaw and neckline. Nose surgery can restore support to a droopy nasal tip. Volume loss can be improved with safe, facial implants that can last forever. These procedures don’t halt aging but they do turn back the clock, so you always look better at any given age than you would have otherwise.

The effects of aging on the face can be disheartening, but we are lucky to live in an exciting time when we can create a positive change to our appearances. Unfortunately, we have not figured out a way to stop the aging process altogether – at least, not yet. Until then, there are a variety of new treatments, many noninvasive, that can help restore a more refreshed, youthful appearance.