The Aging Face Part 4: Facial Surgery for Later Years

The face shows aging with the increasingly wrinkled and blotchy appearance of the skin. But those are just the superficial changes. In the past people attributed the aging of the deeper facial structures primarily to gravity. We now know that the primary cause of structural facial aging relates to deeper photo damage (to the SMAS) and repeated contractions of certain facial muscles deeper still.  Gravity only continues to abet the aging process begun by changes in these deeper tissues of the face.

Your facial muscles have deep and superficial pads of fat, which allows smoother movement of the facial muscles. Between the muscles and the skin there is the SMAS (superficial musculoaponeurotic system), a network of tissue composed of mostly collagen and elastin fibers. So your muscles are supported by fat that is curving forward giving a young person that nice rounded cheek, for example. And the SMAS connects the muscles and the skin, communicating movement between the two. With age, the facial muscles gradually straighten and shorten, the muscle tension strength of the face at rest is increased pushing fat outward. Without getting too technical suffice it to say the muscles lose strength and with age, the facial muscles gradually straighten and shorten. Interestingly, the changes in the muscles, not only force out that underlying fat, but even exert constant pressure on the underlying bone structure. Meanwhile, photo damage is weakening SMAS.

No longer will dermal fillers or BOTOX® suffice to reduce the look of aging. The elements of aging at this point require deeper correction. Don’t forget, this is happening all over the face. The eyelids begin to droop (ptotis), the brow lowers, jowls begin to form, what we sometimes call a “turkey wattle” may form on the neck. The hallmark of a young face is an downward pointing triangular shape formed by those plumped up cheeks and the chin. The older face can be seen as a upward pointing triangle from the bridge of the nose to the jowls, as muscles and the SMAS get lax, and finally the fat and skin are affected by gravity. Basically, the middle third of the face gets longer. Obviously, ptosis (drooping) of the outer eyelid contributes to this effect of a downward pointing triangle. What can be done? Here is a list:

• In a Facelift, the SMAS and the skin are pulled up to a higher position on the face. In fact, this can actually relieve the pressure on facial bones.

• With a neck lift, often combined with liposuction, that “Turkey waddle” is removed.

• A blepharoplasty (eyelift) gives the upper face a rejuvenated look and helps prevent that downward pointing triangle look mentioned previously.

• A brow lift can not only correct for the lowering of the brow, but also eliminate those transverse wrinkles.

• Rhinoplasty is sometimes sought by older people because of nasal tip ptosis. Small imperfections become more obvious with aging. The weakening cartilage and projection of the tip can be addressed.

Just as you take care of your body by eating healthy and exercising, women can choose cosmetic procedures to enhance and rejuvenate their faces. You can indeed age gracefully, and cosmetic surgery can be subtle. Little Rock Cosmetic Surgery Center offers facial cosmetic surgery in a fully accredited operating room. In your consultation, we will discuss exactly what options are best for you.

Dr. Branman

Call Melinda at the front desk to set up a consultation 501-227-0707