How your face ages is a multifactorial process that happens over a number of years. However, many patients often consult with the concern that they have aged overnight. This may be triggered by someone commenting on their appearance or looking at an old photograph. I always explain the ageing process to my patients during the consultation. This helps them appreciate the changes involved and how we can address them.
There are five layers of the face involved in facial ageing. This includes:
- The facial bones
- Deep fat pads
- The muscles and ligaments
- Superficial fat pads
As all the layers go through ageing differently, they need addressing specifically to rejuvenate your face.
What happens to the facial bones and deep fat pads
Ageing affects the facial bones of the skull. There is a gradual reduction in the bones leading to certain changes we see in a mature face. Imagine a table that has a tablecloth and the table starts shrinking, you get excess cloth which will sag. Here, the table represents the bones in the face.
Let’s look at the main areas where this is relevant:
- The eye sockets become larger causing the eye ball to sink in. This creates a sunken eye appearance making you look tired.
- Your cheekbones regress causing your cheeks to flatten. You may look deflated as you lose the lovely curvature seen in a youthful face.
- The hole where the nose connects expands causing the tip of your nose to lower. This deepens the folds between the nose and mouth.
- The jawbone shrinks causing loss of definition to the jawline and chin. Lack of bony support worsens heaviness in the lower face. Any loss of teeth causes loss of support in the mouth area.
All the bony changes affect the layers above it as they form the scaffolding of the face.
The deep fat pads are stuck to the bones and are responsible for the fullness seen in a young face. They help create smooth transitions from one area to the next.
As we age, these fat pads go through 2 changes. Firstly, they decrease in volume. Secondly, they move downwards with gravity. These changes are compounded by the loss of bony support underneath.
Movement of the deep fat pads is responsible for creating:
- Deep skin creases
- Skin grooves
- Fullness in the wrong place
They result in the apple of the cheeks appearing flattened, folds becoming more pronounced and the lower face increasing in volume.
As we age, our lips turn inwards, lose volume and definition. Lines appear around the mouth and the corners of the mouth may be downturned.
Wrinkles caused by muscles
The muscles of the face are in constant motion from the time we are born. They help us communicate as we smile, cry, eat, talk, grimace, shout, frown, and so on. In our late twenties, we get ‘dynamic’ lines (wrinkles) which are lines that appear when we make certain movements such as frown, smile or raise our eyebrows. Over time, and with repeated contractions, the muscles remain contracted to form ‘static lines’ (wrinkles). These are visible even when we are not making these expressions. In some areas such as under the eyes, the ageing muscles are so thin that they allow ‘herniation’ or poking out of structures beneath. This can predispose to eye bags.
Ligaments of the face
Unlike other structures, ligaments tend to be more robust. Some ligaments remain the same while some are lax allowing the descent of structures around them. They can cause tethering leading to specific areas of sagging. This can be seen in the jowls causing uneven bulging as tight ligament pulls at certain points.
Superficial facial fat
There is a superficial layer of fat immediately under your skin. This is very unique. Instead of becoming thinner it actually gets thicker with ageing! The consequence is that any folds in the face become more prominent such as nose-to-mouth lines and mouth to chin lines become more noticeable.
The skin undergoes changes with ageing. We start losing collagen in our thirties and the skin starts to lose its elasticity and water holding capacity. This results in the classic appearance of rough, uneven, loose, dry and saggy skin with deep wrinkles.
The shape of the Face
The overall effect is the loss of the inverted triangle of youth and results in the triangle or square of the aged face.
Addressing facial changes
During my consultation, the approach is to consider all layers of the face and treat where necessary starting with the scaffolding. We use dermal fillers to fill deficits. They compose of chains of sugar molecules (hyaluronic acid) manufactured specifically to last longer than our own hyaluronic acid molecules. These molecules naturally attract water and can hold up to a thousand times their weight in water. This is how they have a plumping effect on the face. Although minor changes are visible immediately after treatment, true plumping effect occurs over weeks.
Once the scaffolding has been addressed, I would consider augmenting areas of concern if required.
Outcomes and longevity vary from person to person and where the filler is placed. Although they can last for 6-18months, they do have to be re-injected to maintain the effects. I only use dermal fillers that have been extensively studied and sourced from reputable UK pharmacies.
Specific muscles that create wrinkles on movement on the face can be successfully treated with Botulinum Toxin by temporarily disrupting the connections between the nerves and the muscles. When the wrinkles have become fixed and present at rest (static lines), the response is not good. They do however get softer with repeated treatments.
Skin laxity can be addressed with medical skincare or skin rejuvenation treatments like injectable skin boosters, microneedling, mesotherapy and medical skin peels in combination with dermal fillers and botulinum toxin.
Patients often come to see me asking to fill a line here or there but as a doctor, it is my duty to educate them. Helping them understand why they are seeing the reflection they see in the mirror.
Once we have discussed how I would plan their treatment they have a good insight into what we can achieve with the available treatments. They also understand that we cannot create what they never had instead we can enhance their own natural beauty-my ethos.