Saving face

I was looking at old pictures of my daughter the other day.  Even though she is only 17 months old, her face is already starting to transform from baby to young girl.  She is losing the chubbiness of her cheeks, the roundness of her face.  Tear - my baby is growing up!

Our face is constantly changing as we age.  But the transitions are more complex than just getting wrinkled.  Have you ever seen a person in their 50s or 60s with perfectly smooth skin, yet somehow they still look old?  The reason is because the structure of our face changes dramatically with time, not just the surface of our skin.  So what happens to our faces?

The bones of our face act as a foundation.  Just as a house sags where the foundation is weak, so does our face (nice, right?).  With time, the bones around our eye sockets receede, contributing to the hollows around our eyes.  Our temples become hollow.  Our upper and lower jaw bones atrophy, decreasing the size of our lower face, and making jowls appear.  Our chins get smaller.  This skeletal resporption changes the proportion of our face, making us look older.  Enter scrulptra and radiesse, two fillers available right now, approved by the FDA for naso-labial folds.  They are used off-label for full facial volumization, injected to help replace the bone loss.  When used properly, they can change the shape of the lower face, allowing a more youthful look.

Above our bones, we have fat.  These fat pads form our cheeks.  When they atrophy, our cheeks become hollow, making our naso-labial folds (the lines on the sides of our mouths) look deeper.  The hollows make us look tired.  Scultpra and radiesse can be used here to restore our cheekbones to their previous glory, in addition to the hylauronic acid fillers: juvederm, restylane, and perlane (all off-label uses).  Hyaluronic acid fillers also work well to fill finer lines and lips (again, off label).  I'll blog more about these separately. 

In addition to the structure of our face, there are surface changes as well.  With time, we lose collagen and make more elastin (think rubber bands....stretchy, saggy).  The more sun exposure you've had in your lifetime, the more loose your skin will be, and the less it "snaps back."  Add in lines from movement, and it equals crow's feet, pucker lines around the upper lip/lower lips, glabellar lines ("eleven lines" between the eyebrows), and forehead lines.  These are corrected with botox and dysport (although they are only FDA- approved to treat glabellar lines; all other uses are off-label).  Plus, the sun causes brown spots on the face and dilated blood vessels, especially around the nose.  For these, often a combination of lasers (like the Fraxel or Active FX, peels, and cosmeceutical creams help.  For saggy areas, Thermage, a radiofrequency device, tightens by using heat to stimulate collagen formation.   

Aging is inevitable.  I see it daily at both home and in my office.  But luckily, modern medicine can help us acheive a natural, healthy look: a volumized face and skin (almost) as soft as a baby's bottom!