November 18th, 2013
Conversely, what makes a face look young and refreshed?
Within seconds of meeting someone, we formulate a subconscious opinion of them based on their appearance:
Young or old?
Friendly or mean?
Someone we can trust or someone we should avoid?
Recall the last time you encountered a person you hadn't seen in awhile - someone who time had not been kind to. How long did it take you to say (to yourself, hopefully):
"Wow. (fill in the blank) looks tired/old/angry/bad."
If your experience is anything like mine, chances are it was before you even said "Hello".
The question is: WHY? What is it that makes us perceive aging changes so quickly?
The answer is volume loss - mainly of the eyes, cheeks, and lips. As we all age, we lose volume in our face. The fat of the face gradually "melts" away, leaving the cheeks looking sunken-in and "skeletal". The muscle on the side of the head - the temporalis - shrinks, leaving the sides of the head indented, which contributes to the skeletal appearance. The bone around the eyes starts to disappear, causing the eyes to also appear sunken-in. This causes the skin to "bunch up" - the most common reason for eyelid surgery. Bone also begins to disappear around the nose, causing the upper lip to elongate and flatten, as well as around the jawline, which accelerates the aging seen in the lower third of the face and neck.
Subconsciously, you "see" all these things, and these subtle changes constitute your instantaneous assessment of someone's age, even if you don't realize what you are seeing. If I were to ask you (and many plastic surgeons, for that matter), you would think for a minute and start telling me about wrinkles, lines, the droopy, extra skin of the cheeks, or the eyelid bags. You probably wouldn't say anything about the lips at all.
What you would be telling me is about the symptoms of aging - what you can easily see. The problem is that if we treat only what you can easily see and identify may mean extensive surgery to correct.
Ironically, the solution to the underlying problem of volume loss in the face is less invasive (and less expensive) that treating the symptoms of volume loss. In many cases, it involves merely replacing the volume that is lost. This is done two ways - with injectable fillers, or with fat injections (from fat harvested via liposuction). Both of these can be used to replaced volume lost in all areas of the face, and are excellent in treating the underlying problem in facial aging.
A new solution is showing major promise in this area - Sculptra. In a series of in-office injections, which take 10-20 minutes, the volume can be restored to the areas that are lacking. I was admittedly skeptical the first time I used it - I just didn't believe that an off-the-shelf product could perform as well as using a person's own fat to restore the volume lost with aging. Quite simply, the results are amazing. Sculptra replicates what can be done with fat injections, but without the downtime of surgery. It works by stimulating your body to produce collagen in the areas in which it is injected - so the results are YOU and not some chemical that is injected that then goes away. It does need to be "refreshed" every year, but the results you see are the result of growth of your own tissue.
Is Sculptra the magic bullet for facial aging? No. If you are looking for a permanent solution to restore volume that is lost with aging, I would recommend fat injections for most people. From a financial standpoint, the "break even" point between Sculptra and fat injections is between 2 and 3 years, depending on how much you need to get the desired result. However, if you are looking for a way to reverse volume loss that is quick and has minimal downtime, or you are not interested in surgery, Sculptra is a great choice.