Facial Aging: Causes and Solutions


Having answered many patient questions either on different websites or personally, I have found that there are several common threads with the majority of these.  With regards to the aging face, there are several finite issues that can happen to us as we grow older.  For the sake of being brief and keeping things relatively simple, we will confine the aging of the face to three different issues and we will offer solutions for each.  Skin changes are those that occur only on the skin (epidermis, dermis).  Gravitational changes are those that occur as a result of the constant force of gravity on our bodies (jowls, cheek hollowing, deep folds, neck banding). Volume changes are those that occur in the face as a result of the loss or displacement of the fat in our face (cheek and temporal hollowing, hollowing around the eyes).
Skin aging is what occurs to the envelope around our faces.  Effectors such as sun exposure, lifestyle, heredity, and medical issues can affect the appearance of the skin.  Issues such as static and dynamic wrinkling, brown spots, loss of elasticity and thinning of the skin are all indicators of aging.  Whether its one or several of these mediators that cause aging, the solutions are always confined to the skin and do not address the surgical signs of aging as we will discuss in the next paragraph.  Facial resurfacing (lasers, chemical peels, dermabrasion ) are good ways to improve skin aging.  Fillers (Juvederm, Restylane, Belotero ) and neurotoxins (Botox, Dysport, Xeomin) are relatively inexpensive, highly effective  and temporary ways to improve the static and dynamic lines of the face.  Skin care products such as Obagi, SkinMedica and Image all work on the surface of the skin to improve discoloration, improve hydration and slowly resurface the skin to make it look more youthful).
Gravity is that constant force on our bodies that is present since we are conceived.  Like all of the tissues in our bodies, this constant force moves every tissue in a vertically downward direction over the years.  As it pertains to the face, along with all other muscular tissue, the superficial muscle of the face creeps in a downward direction and causes the formation of issues such as deepening folds, hollow areas, jowls and neck banding.  All of these signs of aging are amenable to surgery.  Facelift surgery, brow lift surgery, mini lift , etc. are all ways to elevate the muscles of the face and neck to reposition them into a more youthful position.  Remember that because we try to reverse the vertical gravitational effects on the face with surgery, it stands to reason that the resolving vector of force must be in an opposite and VERTICAL direction.  The direction should not be horizontal as this is the difference between natural and unnatural facelift results.   Many surgeons will promote one technique over another and that discussion is beyond the scope of this article. However, I believe that the technique is not as important as understanding the aging process and creating an effective and natural solution. 
Volume loss happens to our entire body as we grow older.  In particular, the face looses volume is some very distinct and predictable areas.  The volume loss in combination with gravitational forces cause the formation of shadows in our faces.  It is these shadows due to concavities, that we and others see as signs of looking tired or aged.  It follows that whether a surgeon tries to camouflage the concavities caused by gravitational descent or tries to supplement volume loss,  the end result is improvement in shadows and a more youthful face.  Volume supplementation either through fat transfer or injectable products such as Voluma or Sculptra can remove shadows and give one's face a heart shaped appearance which is interpreted as youthful.  
As one can see, facial aging is truly a multifactorial issue with a complex set of potential solutions.  The goal in providing a treatment is always to achieve as natural and long lasting of a result as possible staying within the context of each patient's unique face.
Article by
Jacksonville Facial Plastic Surgeon