The most obvious sign of aging in the face is the loss of volume. Until recently, we would try to restore a youthful appearance by lifting the tissues that have the appearance of having fallen. We now know that a lot of that "fallen" appearance is actual deflation. Sure, there are factors such as the loss of elasticity and descent of tissues from gravity, however if only one of the factors is dealt with, then you will never look like they did in the past. I use old photographs of the individual that I am considering for rejuvenation to determine what has changed so I can make the correct surgical and nonsurgical approach. I used to like to start with photographs from high school her college graduation or perhaps a wedding photo and then see how the face progresses into the 30s and 40s. The majority of my patients come in to my office for facial aging in the 50s or 60s. I have seen quite a few patients take a proactive approach and get an opinion on what to do in their late 30s and early 40s. Sometimes in the individual's did not like there facial shape when they were young and liked the sculpted look they developed in the early adulthood years. With the help of Vectra 3D-( three dimensional photographic) system we can analyze exactly what has taken place as the face changes over the years.
Using this technology I can map out the plan for restoring the desired shape and appearance to the face. The first building block is to restore volume in the critical areas such as the cheeks, the jaw line, and the brow and temporal area. Other areas of concern include the area around the eye especially the hollow of the upper eyelid and the junction between the eyelid bag and the cheek (tear troughs).
The lip often loses volume and needs to get resculpted. In the lip it is particularly important to look at what the original lip volume-wise. If one tries to change naturally small lips into full lips the results can be rather obnoxious. The lip in particular loses volumes in two areas: the first being the actual lip volume and where the pink vermilion is visible in the front view and secondly in the lip line where the normal skin and the pink vermilion interphase. It is that second area of the lip line which is critical to treat with volume before addressing the overall shape of the lip. This lip line filling has a benefit of erasing fine lines that are often blamed on "smoking" or drinking through a straw. The volume loss in this area combined with loss of elasticity results in the spine lines which are often more visible when you put on lipstick and the lipstick goes up into these crevices. The 10X mirrors that are often used to apply makeup often exaggerate these lines and add to the magnitude of the concerns. Once these are restored, the actual shape of the lip including the improvement of the corners of the mouth are dealt with volume restoration.
The cheeks and the areas just below it are often areas that are misunderstood by plastic surgeons and dermatologists that have a tendency to put too much volume into the cheeks and an unflattering exaggerated way. This is often made worse by the over stuffing of the lips creating a caricature of youth rather than restoring the youthful natural appearance. Another area that loses volume and can easily be treated is the jaw line. Volume placed in front of the "jowl" and near the angle of the mandible can re-create the beautiful jawline and strengthen the chin that will set off the contrast between the f