How Our Faces Age (And a Few Misconceptions)

Gilbert Lee, MD
Article by
San Diego Plastic Surgeon

Facial aging is a fascinating subject to study and understand. It isn't a fun subject to live with, but it is a natural part of life that everyone will face. So why is it that as we get older we look, well, older? The answer is that a number of small changes combine to make you look aged. These small changes can be categorized into three main groups: skin surface defects, volume loss, and skin redundancy. Most people have all three in varying ratios and the combination creates an overall aged appearance.

The first thing that usually happens is skin surface imperfections. These imperfections include fine lines and hyperpigmenation, both of which contribute to an aged appearance. The primary culprit for these is the sun. The more time you spend in the sun, the more damage you cause your skin. Of course, you can minimize this with regular, quality skin care. Proper cleansing, moisturizing, and most importantly – sunscreen – will limit the sun's damage to your skin. If you like being tan, spray tanning is much healthier for your skin.

The second thing that people experience, but may not notice is volume loss.  More often than not, when a patient comes in with loose skin, it is not that the skin is stretched but rather that the substance or fill underneath is dissappearing. Your skin is designed to wrap around your face.  As you lose volume in the face, the skin loses its tension and starts to look saggy. So why do we lose volume? As we age our body breaks down the collagen in our skin (the connective tissue that gives our skin thickness and elasticity), the fat underneath the skin dissolves, and even the bones in our faces resorb. To further complicate this problem, our face doesn't lose volume evenly across the face. Every person loses volume at different rates in different areas.

The third and final problem is skin redundancy. This is usually the last sign of aging to occur and can be limited by proper maintenance of the first two issues. Over time, the tension and tautness of the skin starts to relax, resulting in skin redundancy. This most severe facet of aging is treated surgically, whereas the first two signs of aging can be treated non-surgically.

After knowing what causes your face to appear aged, we can begin treating. To create a natural looking appearance, you have to treat all three issues individually. The skin surface can be treated with laser treatments and medicated creams.  The volume loss is corrected with fillers or fat injections.  Finally, the skin redundancy is treated with a surgical lift or tightening (facelift, blepharoplasty, browlift). By applying all the tools we have to treat each problem individually (and in moderation), we can achieve a younger, natural look that still looks like you, just a younger you. Where people often run into problems is when they try to treat all three problems with just one solution. This is most commonly seen in people who have treated all of the aging effects with just facelifts, leading to the "windswept" look (think Phyllis Diller, Nancy Reagan, Joan Rivers).

Remember, you didn't age in one way, so don't expect to reverse it using just one method.  And, don't underestimate the power of lasers and volume replacement in facial rejuvenation.  They should usually be the first treatments against aging.  And, when you are finally ready for a facelift explore all options as there are less invasive surgeries like the Changes Rapid Lift which can achieve your goal with less downtime and cost.