People often present knowing that they look older but not quite sure how they have aged. Often its after the kids have grown up, after stressful periods such as relationship breakups and illness, or retirement that people look in the mirror and wonder who is looking back. They don’t feel the way they look, and wonder where the years went. Usually they’ve been so preoccupied with everyone else’s needs that time has just passed without them realising. Knowing how one ages helps in choosing the best treatment to restore your former self.
Sadly, the face doesn’t age in one way, as then one type of treatment would fix everything. Let’s look at how we age and suggest treatments to correct this.
Loss of collagen and elastin
As we age the body becomes slower at making collagen and elastin fibres. The fibres that are made are also weaker than those made in youth. Hormonal changes such as menopause accelerates this deterioration. The result is skin that looks finer, loose and if pinched has a delay before it moves back into position. We call it “crepe paper” like skin. Often this skin seems to bruise more readily when traumatized. This is mostly seen in the once porcelain type skin of the English patient. This type of ageing is most noticeable around the eyes, the neck and often the jowls. To improve this problem we must perform procedures that stimulate collagen. The gold standard for this is Thermage-CPT. Other treatments include injectable skin hydrators, plasma treatments and skin rollering.
Studies have shown that removal of pigmentation is the treatment that provides the greatest anti-ageing effect. This is not surprising when one considers that 95% of damage to the skin comes from sun exposure. Australia’s proximity to the sun and ozone hole means that Australians receive more direct rays than anywhere else in the modern world. Is it such a surprise then that the English skin which is use to a temperate climate ages so rapidly when people migrate here? Even when we pop out to put washing out to dry or walk to our cars we receive incidental exposure to UV rays, hence we should be wearing our physical barrier sunscreens (with UVA and UVB broad spectrum cover) every day regardless. Some pigmentation is from the skin’s ability to overcompensate in healing and cannot be easily removed. This type of hyperpigmentation is often seen in darker skin types such as Asian, Aboriginal and Negro. Treatments that help pigmentation are chemical peeling, IPL (intense pulsed light) and the dermal infusion device (“super or medical microdermabrasion”).
Fat loss and redistribution
Humans associate round full faces with health and youth. Who doesn’t think a baby is cute with its chubby cheeks? As we age we lose the fat in our face, our mid-face drops, jowls develop and we look drawn. Without the fat to push out the loosening skin together with the concurrent collagen/elastin loss we begin to notice naso-labial and marionette lines more. In the past patients often rushed to get face-lifts to fix this but were disappointed with results because a facelift can only remove excess skin, not restore the youthful volume loss. Smarter patients opted for fat transfer, which was the only thick filler available to do the job. Fortunately, with the advent of the “Natural lift” fillers, amazing and instant results have been seen in correcting mid-face volume. To give you an idea of mid-face volume correction, compare Charlie’s Angel Jaclyn Smith and now 70-year-old Raquel Welch with their former selves. Note their mid-face. Both have kept their cheeks and look great.
As our muscles move our skin folds to create lines. This is particularly noticeable in the upper face around the eyes (crows feet), between the eyes (frown), in the forehead (worry lines) and along the side of the nose (bunny lines). Wrinkle relaxers reduce this movement and hence treat and prevent lines. Over time constant folding can create depressions in the top layers of the skin resulting in the need to fill these areas as well as reduce movement. This is where dermal fillers are used. In the lower face movement is far more important and extensive so that only small amounts of wrinkle relaxer can be applied. Fillers are the answer here.
Combination lines and depression lines
In the lower face we see more depression type lines and so use fillers. These lines come about with the loss of fat and collagen. They are commonly seen in the orbits, naso-labials and marionettes. If the depressions are deep they will need volume fillers whilst if finer then dermal fillers are the appropriate choice.
The lips are a very special area of the face that undergoes a distinctive ageing process. As we grow older our gums recede, the natural firm rim around our lips (the vermillion border) deflates and the pulp of our lip turns inward. The result is a smaller, asymmetrical lip with lines around it. If one smokes or plays an oral musical instrument then this is accelerated. This ‘concertina’ look is best restored by first correcting the vermillion border and then filling the peri-oral lines. This process provides the most satisfying and long lasting result rather than just treating the mouth lines. Restoration of the lip is one of the most anti-ageing treatments available.