4 Paths to Understanding and Treating the Aging Face

Advanced Aesthetics

Why does someone look older? What makes one person look older than another? We all look at our own face in the mirror every day, and sometimes suddenly we wake up one morning and notice things have changed. We look at each other and compare ourselves to one another. “She really looks good” or “Life has really taken its toll” are descriptions of our evaluation of looks compared to our expectations. What are the subtle changes that make one person look older and another look fresh and healthy and young? There are four main areas that age us, and we take a medical spa approach to facial rejuvenation at our cosmetic surgery practice here in Coeur d’Alene. All four can be addressed by minimally invasive cosmetic treatments and procedures.
1. Skin tone
Freckles, brown spots and inconsistent pigment, as well as redness and vascularity, all contribute to the appearance of the skin. Time and exposure to the elements contribute to these imperfections. The skin tries to protect and repair itself, and the result is browns and reds. These problems can be easily treated with a combination of skin care, photofacial IPL treatments, and a variety of lasers including PicoSure™ Focus and fractionated CO2 laser treatments.
2. Texture
Fine lines, wrinkles, scars, stretch marks, enlarged pores, and acne scarring are examples of textural skin changes that contribute to a ‘’weathered” appearance. Trauma, infections, and the loss of collagen and elastin in the skin from aging are the causative factors that make our skin less than smooth. We have the ability to stimulate the body to build new collagen and elastin by creating a very precise type of injury to the skin, which turns on the reparative process and stimulates collagen and elastin at a cellular level. How do we do this? With energy-based devices using lasers, radiofrequency, and ultrasound, we force the skin to build new collagen with a specific type and placement of heat. You can see this in the patient pictured below, who received a CO2 laser treatment for crow’s feet.
Close-ups of a female patient's left eye area before and after a CO2 laser skin treatment to reduce crow's feet wrinkles.
Active wrinkles are another issue. They are caused by muscular contractions and creasing of the skin. Certain areas, such as the glabellar frown lines between the brows and crow’s feet lateral to the eyes, can be treated by relaxing the muscles with neuromodulators such as BOTOX® or Dysport® (which is what we like to use at our Coeur d’Alene practice) and XEOMIN®.
3. Tautness
Skin laxity is a telltale sign of looking older, and factors at play are similar to what we see above with textural changes. Collagen and elastin volume in the skin gradually declines starting in the mid-20s, and the rate of loss depends on each person’s health, overall skin care, sun exposure (mitigated by the use of sunscreen) and smoking. The chemicals in smoke prevent the skin’s ability to heal itself when exposed, giving way to poor texture and laxity.
Depending on the severity of the laxity, we have various tools in the toolbox to tighten. Again, laser energy is often a very effective modality and is the most often used. Superficial energy such as PicoSure Focus treatments or SmartSkin™ fractionated CO2 are able to penetrate deep enough to cause collagen contraction and remodeling. Other treatments such as Ultherapy® use focused ultrasound to heat and contract tissues. Minimally invasive surgical procedures using laser fibers under the skin, such as PrecisionTx™ or radiofrequency fibers by Thermi®, work by heating the skin and subcutaneous network from below the surface to tighten loose skin. And finally, skin can be removed and tightened through surgical intervention in a neck lift or facelift.
4. Volume
Lastly, and probably the least appreciated aging factor, volume changes take place in everyone as the face and neck age. Not only does the skin become thinner, but the underlying support structures of the face and neck diminish. The bones become thinner, the muscles atrophy, and the fat pockets that give our face contour and 3-dimensional projection evanesce. We also have some volume increases under the chin and along the jawline, creating jowls and double chins.
So, understanding these volume changes and addressing them specifically and accurately is one of the most important anti-aging treatments that we provide. Injectable fillers replace lost volume in areas such as the temples, tear troughs (addressing the dark circles under the eyes), cheeks, lips and vertical lip lines, oral commissures (the downturned corners of the mouth), marionette lines (extending from the corners to the chin) and the jawline. A variety of filler products are available. These fillers are sterile, soft, injectable cohesive gels that are injected into areas of volume loss. They plump the area returning the tissue back to its original volume. The goal is not to look over-filled and “Hollywood” but just a younger version of you. These fillers remain anywhere from 6 to 18 months. We use Galderma products in our practice: hyaluronic acid (HA) fillers include Restylane®, Restylane Silk, and Restylane Lyft. Two new products have just been FDA-approved in the United States: Restylane Defyne and Restylane Refyne. Stay tuned for more information on these new HA fillers. Other alternatives include JUVÉDERM®, VOLUMA®, BELOTERO®, RADIESSE®, ArteFill®.
There’s also Sculptra®, a unique formulation used as a biostimulator to help you build your own tissue. For its ability to accelerate collagen growth, we call Sculptra “fertilizer for your face.” The volumizing and rejuvenation of the skin we see with Sculptra is fantastic, and it serves as a great tool for some of our patients. Sculptra last for 2 or 3 years and may take several treatment sessions for the best results.
Why does volume matter? If you think about it, not treating flat cheeks, but instead pulling the skin back tight with a facelift might make someone look weird and “swept back.” Have you ever seen that look?
A combination of some or all of these above treatments for tone, texture, tautness, and volume loss represents the latest innovations in treating the aging face and neck. Will facelifts be obsolete in the future? It appears that they just might.
We all continue to have birthdays as Time marches on… but we can also continue to look young, fresh and healthy.

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