Facial aging is the result of changes that occur at multiple anatomic levels and is manifested as an increase, decrease, or downward descent of skin, fat, muscle, and bone. Facial anatomy is initially determined by genetics but a spectrum of behavioral aspects such as skin care, sun protection, weight gain or loss, stress, and smoking can alter the timeline in which aging becomes visible when we look in the mirror. Although the skin provides the most superficial evidence of aging, it is also a reflection of the changes that have occurred below the surface. It is vital to consider the totality of these changes to understand which treatment options will be of greatest benefit to the individual patient who is concerned about aging of the face, neck, and brow.
Dr. Forley develops a customized treatment plan for each patient based on his specialized plastic surgery training and the extensive clinical experience that he has accumulated in his private practice in New York where he is affiliated with the Mount Sinai Medical Center. He performs his procedures under sedation anesthesia administered by a board certified anesthesiologist in his Joint Commission accredited office based surgical facility. In some cases, aging changes can be addressed in a minimally invasive, non-surgical approach that will be discussed during your consultation.
Although the factors that determine the visible signs of aging will govern the best treatment approach, facial aging is a progressive process that does not uniformly impact the face, neck, and brow. However, an analysis of the underlying causality of those changes enables an anatomically guided strategy that results in a natural result. Restoring rather than altering your anatomy should be the goal when considering aesthetic surgery procedures of the face, neck, and brow.
The skin is the largest organ of the body and is the primary component of what is known as the integumentary system. Due to its presence on the body surface, it is most directly subject to the degrading effects of our environment such as exposure to ultraviolet (UV) light from the sun. Premature aging is predominately the result of prolonged exposure to UV light due to its negative impact on the collagen and elastic fibers that are responsible for the structural integrity of the skin. Many skin cancers are also primarily caused by repetitive contact with UV radiation. Other factors which contribute to skin aging such as repetitive facial expressions that crease the skin, loss of skin support from diminished facial fat and bony volume, and the downward forces of gravity are exacerbated by the adverse impact of UV exposure on skin quality and the decline in the regenerative capacity of the skin over time.
The surface contours of the face are principally determined by the underlying fat compartments. The location and amount of fat in each of these discrete locations are largely responsible for the deflated cheeks, deepened folds, jowls, and loss of jawline and neck definition that characterize the aging face. Addition of volume to restore the youthful convexity of the face combined with repositioning of displaced facial fat compartments are key components of an inclusive approach to facial aging that is geared towards achieving a natural result.
In some cases, excess fat can accumulate in undesirable locations such as the neck. This alters the acute neck angle that is associated with youth and, along with redundant skin, is a common reason for patients stating that “I hate my neck”. Reducing fat in this location is frequently performed as part of an overall approach to rejuvenation of the neck.
Muscles of facial expression are important elements of our individual identities. However, they gradually contribute to an exacerbation of the signs of aging. Less resilient skin results in a diminished capacity to resist contraction of the underlying facial muscles. As a result, a condition known as dynamic discord develops in which the forces of muscle contraction generate an increasingly detrimental effect on the appearance of the less resilient skin. Left untreated, an array of etched lines and more severe wrinkles, that are repeatedly reinforced by animation, become progressively worse.
Altered integrity of the thin platysma muscle in the neck results in visible muscle bands or cords as we get older. The youthful angle of the neck is concealed by the combination of prominent platysma muscle bands, fat accumulation under the chin, and skin laxity. Although in some cases, this aspect of aging is isolated to the neck, it often is part of a continuum of aging that extends from the face and can include the brow.
The bony skeleton of the face provides a supportive platform for the overlying skin, fat, and muscle. Patients with more prominent cheekbones or wider jaws will often benefit from a delayed appearance of the stigmata of aging. In those with less skeletal support, the compensatory bony anatomy is absent and earlier onset of hollow cheeks, jowls, brow hooding, and sagging skin is frequently the result. However, regardless of pre-existing anatomy, the bony skeleton also undergoes a gradual loss of volume with aging that can ultimately result in a worsening of the aging process already underway in the soft tissues of the face.
The extent of changes in the skin, fat, muscle, and bone of the aging face are all considered when deciding on a surgical versus a non-surgical approach. A facelift, neck lift, or brow lift will often provide the most comprehensive solution. Dr. Forley will discuss which options are best for you during your consultation and also provide you with non-surgical alternatives to help you decide on a treatment option that best suits your needs and lifestyle.
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