Let's get right to it and begin with the skin. One of the first changes we see is a change in texture, in which the smooth skin of our youth is gradually replaced by a roughened, irregular surface. The skin also loses elasticity and collagen so that what was once tight and firm is now loose and sagging. The loss of elasticity combined with cumulative effect over the years of the facial muscles creating "squint lines", "laugh lines" and so on leads to the formation of wrinkles. The understanding that many of the lines of the face are due to excess muscle activity led to the development of the cosmetic use of Botox® to help reverse these changes, and Botox® injections are the most popular non-surgical cosmetic procedures performed today.
Gravity does play a role in aging but its' importance has been overrated. One area of the face that does sag is the region containing the eyebrows and upper eyelids, and this appears to be a result of both gravity and the constant pulling effect of the eyelid muscles. In women, the youthful arc of the eyebrow becomes flattened, creating a weary or tired look. This aging process can be easily corrected with a brow lift. In fact, many patient who come to see me for correction of excess upper eyelid skin through a blepharoplasty would benefit most from a brow lift.
As we move down the face, we see sagging of the cheeks with the formation of folds of skin around the upper lips and the corners of the mouth along with the dreaded appearance of "JOWELS". Over the past several years there has been a major shift in thinking as to why these changes occur. Traditionally, plastic surgeons blamed gravity and the only treatment was to pull and lift. Now we realize that a big factor is loss of volume in the soft tissues so that areas of the face begin to collapse or "deflate" as we age. In the neck, the loose and sagging skin is a result of both skin changes (loss of elasticity, etc.) and a loss of tone of the underlying muscle layer.
This recognition of volume loss has led to a surge in non-surgical treatments for early signs of aging, such as fat injections and injectable fillers such as Restylane® and Radiessse®. When the signs of aging become more advanced, these procedures are still helpful as supplemental techniques to enhance the more traditional procedures, such as a face lift.
The next installment will cover the age related changes that occur in the breast and body.