The face ages through what are called the “3 D’s” – descent, deflation, and demarcation. UV damage to the skin, loss of collagen in the dermis, loss of subcutaneous fat, and loss of bone density contribute to the 3 D’s. Therapeutic techniques must address the underlying anatomic basis for the cosmetic problem.
It is useful to break the face down into 3 aesthetic regions. The upper third includes the hairline to the glabella (brows), the middle third includes the glabella to the nose, and the lower third from the nose to the chin.
Aging changes in the upper third include brow ptosis (droop), glabellar creases between the brows, and forehead rhytids (wrinkles). A surgical brow lift is often needed to correct brow ptosis. However, in mild cases of brow ptosis, Botox can provide an excellent brow lift without the down-time of surgery. BOTOX works very well for forehead and glabellar creases. Sometimes, a dermal filler such as Restylane or JUVEDERM is needed to fill in persistent glabellar creases.
Aging changes in the middle third of the face include baggy and excessive eyelid skin, eyelid ptosis (droop), puffy or sagging lower lids. These changes are best addressed surgically through an upper and lower lid blepharoplasty. In some patients, hollowing of the lower lids occurs with demarcation of the lower rim of the orbit (eye socket) or a depression near the side of the nose called a tear trough deformity. These patients are best served by adding volume to this area with dermal fillers. Prominent nasolabial folds (laugh lines) are also treated very effectively with dermal fillers. Nasal tip ptosis (downward pointing of the nose) develops due to loss of structural support around the nasal alae. Again, dermal fillers work very well at correcting this deformity by increasing volume and support in this area.
Aging changes to the lower third of the face include jowls (pronounced melolabial folds) and loss of lip volume. Loss of lip volume presents as lip ptosis (curling in of the lips) with loss of the vermilion (red) border, a poorly defined “cupid’s bow”, and loss of the upper and lower “pillows”. Fine vertical lines become more prominent. Dermal fillers are ideal choices for correcting both melolabial folds and lip enhancement.