Global approach to aesthetics
For many years, aesthetic medicine has mainly focused treating the obvious visual manifestations of ageing rather than the root causes themselves, primarily due to lack of detailed anatomical knowledge.
According to current knowledge the, following factors are responsible for the appearance of the visible signs of facial ageing(ref. 1) :
- Degenerative changes occurring in the skin and connective tissues (i.e elastosis, fibrosis)
- Loss of skin tone and elasticity occurring in the overaal tissue complex due to the effects of the ligament laxity.
- Decreased supply of nutrients and fluids to the skin and subcutaneous tissue.
- Decreased volume in the deep fat pads, which act as at the biomechanics support structures to the overlying skin envelop
- Ptosis/descent of the destabilised soft tissues due to the loss of biomechanics support under the effect of gravity
- Hypertonia and volume loss of the muscles of the facial expression
- Tilting in the balance of power between the depressor and elevator muscles, in favour of the depressor muscles.
Adapted from Charles.H Thorne, plastic surgery
Aging changes in the face. 1. Forehead and glabella creases. 2. Ptosis of the lateral brow. 3. Redundant upper eyelid skin. 4. Hollowing of the upper orbit. 5. Lower eyelid laxity and wrinkles. 6. Lower eyelid bags. 7. Deepening of the nasojugal groove. 8.Ptosis of the malar tissues. 9. Generalized skin laxity. 10. Deepening of nasolabial folds. 11. Perioral wrinkles. 12. Downturn of oral commissures. 13. Deepening of labiomental crease 14. Jowls. 15. Loss of neck definition and excess fat in neck. 16. Platysmal bands.
Global treatment options
Filler treatments addresses only ptosis and atrophy of facial tissues. It does not address, and has nearly no effect on, the quality of the facial skin itself. Consequently, facelifting/filler treatment is not a treatment for wrinkles, sun damage, creases, or irregular pigmentation. Fine wrinkles and irregular pigmentation are best treated with skin care and resurfacing procedures. Most facial creases will not be improved by facelifting (nasolabial creases), and even if improved somewhat, may still require additional treatment in the form of fillers or muscle-weakening agents.