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The Skinspirations Rationale for Facial Rejuvenation


One of the main causes of the changes we see in our face as we age is the loss of both fat and bone volume that occurs in certain facial areas faster than others, starting with fat loss above & below the eyes in our 20's.

Facial fat compartments are located both above & below facial muscles, with ligaments forming their boundaries. As the fat in a compartment shrinks with age, grooves develop where the ligaments are located, as in this example.

Grooves develop over the ligaments dividing facial fat compartments

Grooves develop over the ligaments dividing facial fat compartments

The depressions under the eyes get deeper over time & give us a tired appearance & can make the lower lids look baggy.
aging
In our 30’s the fat in the upper cheeks begins to shrink and eventually, with less fat to hold up the skin, the cheeks sag down to produce jowls and deep folds from the corners of the nose down to the mouth.

We also start losing bone, which is the frame upon which our face is suspended. Like fat, some bony areas start to shrink faster than others, especially around the eye sockets, under the nose, around the mouth & chin, and the outer jaw line. As both bone and fat shrink, the skin without support begins to sag.

To understand how much volume we’re losing from our face, consider that we lose about 1 teaspoon of fat & bone each year after the age of 25, so that by the age of 50, we've lost about 1/2 cup of facial volume.

One of life's cruelties associated with facial aging is that we tend to lose fat from the upper & mid face before losing fat in the lower face. As the upper face loses volume, the skin essentially loses its underlying frame & the face starts to sag. The inverted triangle shape of the youthful face becomes a bottom-heavy triangle as we age, with some of the skin even slipping down under the chin.

Replacing volume while we're young is a way to prevent the clock from advancing. When we try to restore volume in our 40's & up, it takes more "teaspoons" to get back those youthful contours. Luckily once we've restored the volume, only occasional small touch ups are needed to maintain the results.

Age-related fat & bone loss produces 3 dimensional changes that require a 3-D solution.

Left Photo - My photo from 2005 Center Photo - Notice bone loss in jaw & sagging in 2010   Right Photo - In 2011 after Sculptra to cheeks & jawline

Volume loss from the front looks very different from volume loss seen from the side, but people obviously see their face in a mirror from the front. Bone reabsorption at the back of the jaw, the chin, & under the nose that occurs with aging, along with fat loss, shrinks parts of the frame that originally held up your facial skin, which is the canvas. The loss of the underlying frame leads to jowling, deepening lines, thinning, longer lips, downward displacement of the nose, lengthening of the distance between the nose & the upper lip, less forward projection of the chin & the cheeks & increasing skin below the jawline.

before and after photographs of a woman's facial side views, illustrating the appearance of a tighter neck after adding volume to the jaw

Our patient before & after Juvederm Voluma XC to improve the jawline

The foundfacial-volume-skin4ation - Like building a house, before you can address the windows or the roof, you need to put in a foundation. People who are noticing multiple facial areas starting to look older are in need of restoring the foundation. For this, my #1 choice of product is Sculptra, whose results can mimic the appearance of bone as well as fat & lasts at least 2 years. Sculptra is a tissue stimulant which over several treatments done at least a month apart, subtly & slowly builds up the foundation to make the canvas again fit the frame. Other fillers can be used to build up the foundation as well.

The walls - The framing of the walls on top of the foundation can be achieved with stiff dermal fillers like Juvederm Voluma & Radiesse, which by reframing the skin, lift the areas below those treated as well.

Details like windows, shutters, etc. - Other softer dermal fillers like Juvederm, Restylane, etc. are used to fill individual wrinkles, enhance cheeks & lips, lift brows, etc. Decreasing & then preventing wrinkles that have developed from repetitive muscle movements, like smiling & frowning, is done every 3-4 months, usually, with muscle relaxant treatments like Botox Cosmetic.

Replacing the roof - Fractionated laser resurfacing like Profractional, Laser Peels or a series of SkinPen microneedling treatments replaces old, damaged skin with brand new skin that has a fresher, younger looking texture.

Paint - Maintaining the new look on the most exterior layer of the house is done with a combination of at-home professional skincare products & periodic in-office skincare treatments. Our estheticians will be glad to go over recommendations based on your skin type & concerns.

If you’re new to cosmetic treatments this can seem like an overwhelming amount of information but as you can see from the length of this handout, there isn’t enough time to go thru this adequately during a consultation. It is not intended to pressure you into building a house. Most new cosmetic clients start with small steps, understandably, & this material hopefully helps you understand the rationale of an overall anti-aging facial strategy.

If you are interested in learning more about how facial volume treatments can improve your appearance, schedule a complimentary consultation by registering online here or by calling 727-571-1923.