Abstract
The face does not age as one homogeneous object, but as a result of several dynamic components. Changes that occur with facial aging involve a complex interaction among the bone, skin, soft tissue, support ligaments, and septa. Facial aging is a multifactorial process. To properly restore the youthful facial appearance, it is essential to understand the facial morphological changes over time. A balanced approach to facial rejuvenation between bone and fat volume augmentation and soft tissue envelope repositioning will avoid the distortions of either approach in isolation. Skeletal resorption can be improved with calcium hydroxyapatite injections or implants. The loss of volume in fat compartments can be restored with fillers or fat grafting in specific deflated fat compartments. The SMAS, the retaining ligaments, and the lid structures can be modified with surgery. Botulinum toxin is useful to reduce the increased muscular resting tone present in aging. Skin rejuvenation can be performed with retinoids, laser resurfacing, and peels. To achieve an integral rejuvenation, we should individualize the treatments and perform them step by step.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Farkas JP, Pessa JE, Hubbard B, Rohrich RJ. The science and theory behind facial aging. Plast Reconstr Surg Glob Open. 2013;1(1):e8–e15.
Varani J, Spearman D, Perone P, et al. Inhibition of type I procollagen synthesis by damaged collagen in photoaged skin and by collagenase-degraded collagen in vitro. Am J Pathol. 2001;158:931–42.
Pessa JE, Nguyen H, John GB, et al. The anatomical basis for wrinkles. Aesthet Surg J. 2014;34(2):227–34.
Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, et al. Update on facial aging. Aesthet Surg J. 2010;30(Suppl):11S–24S.
Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27.
Schaverien MV, Pessa JE, Rohrich RJ. Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg. 2009;123:695–700.
Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. 1992;89:441–9; discussion 450–451
Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg. 2000;26:1107–12.
Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg. 2007;120:1367–76. discussion 1377
Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. 2008;121:2107–12.
Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg. 2008;121:1804–9.
Rohrich RJ, Arbique GM, Wong C, et al. The anatomy of suborbicularis fat: implications for periorbital rejuvenation. Plast Reconstr Surg. 2009;124:946–51.
Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg. 2009;124:266–71.
Wan D, Amirlak B, Rohrich R, Davis K. The clinical importance of the fat compartments in midfacial aging. Plast Reconstr Surg Glob Open. 2013;1:e92.
Gierloff M, Stöhring C, Buder T, et al. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012;129:263–73.
Gosain AK, Klein MH, Sudhakar PV, et al. A volumetric analysis of soft-tissue changes in the aging midface using high resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg. 2005;115:1143–52; discussion 1153–1155
Wan D, Amirlak B, Giessler P, Rasko Y, et al. The differing adipocyte morphologies of deep versus superficial midfacial fat compartments: a cadaveric study. Plast Reconstr Surg. 2014;133(5):615e–22e.
Ramanadham SR, Rohrich RJ. Newer understanding of specific anatomic targets in the aging face as applied to injectables: superficial and deep facial fat compartments--an evolving target for site-specific facial augmentation. Plast Reconstr Surg. 2015;136(5 Suppl):49S–55S.
Le Louarn CL, Buthiau D, Buis J. Structural aging: the facial recurve concept. Aesthet Plast Surg. 2007;31:213–8.
Cotofana S, Fratila AA, Schenck TL, Redka-Swoboda W, et al. The anatomy of the aging face: a review. Facial Plast Surg. 2016;32(3):253–60.
Wong CH, Mendelson B. Newer understanding of specific anatomic targets in the aging face as applied to injectables: aging changes in the craniofacial skeleton and facial ligaments. Plast Reconstr Surg. 2015;136(5 Suppl):44S–8S.
Brandt MG, Hassa A, Roth K, et al. Biomechanical properties of the facial retaining ligaments. Arch Facial Plast Surg. 2012;14:289–94.
Shaw RB Jr, Katzel EB, Koltz PF, et al. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr Surg. 2011;127(1):374–83.
Pessa JE. An algorithm of facial aging: verification of Lambros's theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg. 2000;106(2):479–88; discussion 489-90
Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg. 2012;36(4):753–60.
Kahn DM, Shaw RB Jr. Aging of the bony orbit: a three-dimensional computed tomographic study. Aesthet Surg J. 2008;28(3):258–64.
Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthet Plast Surg. 2007;31(5):419–23.
Pessa JE, Zadoo VP, Yuan C, et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg. 1999;103:635–44.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Guisantes, E. (2019). Beauty and Aging. In: Pinto, H., Fontdevila, J. (eds) Regenerative Medicine Procedures for Aesthetic Physicians. Springer, Cham. https://doi.org/10.1007/978-3-030-15458-5_4
Download citation
DOI: https://doi.org/10.1007/978-3-030-15458-5_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-15457-8
Online ISBN: 978-3-030-15458-5
eBook Packages: MedicineMedicine (R0)