We used to think the skin on our faces simply sagged from gravity, but now we know better! Aging of the face results from complex interactions at multiple anatomical levels including our skin, subcutaneous fat, muscle and even the underlying bone. Changes at all of these levels cause the face to look older with our advancing chronological age. How can we use this new knowledge to look younger? Successful rejuvenation requires careful consideration of these interactions for an optimal, natural result.
A youthful face is full and balanced; the skin is smooth and unlined, without brown spots and blotches. One can make an analogy with an inflated ‘balloon’ covered with tight, elastic Lycra(r). Much of the change in our faces is actually due to loss of volume in the underlying bone of facial portions of our skull. We lose our ‘cheeky’ cheekbones, chin, fullness in our temples and behind our lips. Our eye sockets hollow out from the bone shrinking around our eyes. With age, there is also decreased production of the natural hyaluronate that volumizes our faces and atrophy of subcutaneous fat pads and the overlying skin droops due to loss of this underlying support, which may be exacerbated by the sun damage to our skin. The ‘balloon’ deflates and the overlying Lycra(r) simultaneously becomes less elastic, resulting in sagging. Although perhaps an oversimplification, this analogy is helpful in understanding that facial aging is not simply due to wrinkles in the skin. Furthermore, dynamic lines associated with facial expression become exaggerated due to the combined atrophy of overlying subcutaneous fat pads and reduction in skin tightness; this has been referred to as ‘relative’ muscle hypertrophy. These are the muscles we treat with Botox at Hawaii Medical Skin Care.
Numerous minimally invasive dermatological procedures have been developed which address changes associated with facial aging to recreate a youthful appearance. The unrestrained demand for such procedures may reflect an intrinsic reverence of youth and beauty, which according to the evolutionary theory reflect health and increased reproductive potential. Psychological studies show that overactive or hyperkinetic facial lines can profoundly impair social function. Furthermore, facial rejuvenation procedures appear to have a significant positive impact on quality of life.