To an artist, the perception of a youthful face is based on light, shadow, shapes, and how these elements relate to one another. The aesthetic goals of facial rejuvenation are to provide a balanced, harmonious and natural look without creating an artificial (“frozen” or “paralyzed”) appearance. 

The youthful face has an ample amount of volume, which allows for a smooth transition from one area to the next. This volume distribution confers a well-rounded, three-dimensional topography with a series of arcs and convexities. With age, these smooth transitions disappear and give rise to sharper delineations. 

Bone reabsorption leads to decreased bony support and dynamic changes in the subcutaneous fat, leading to a lower brow droop (ptosis), less lateral cheek projection and a deeper nasolabial fold. 

Volume loss combined with solar damage leads to the appearance of fine lines and wrinkles as well as skin discoloration, which leads to an aged appearance.

In general, a combination of anti-aging treatments (Botox®/Dysport®, soft tissue fillers, laser treatments) appear to increase the longevity of cosmetic outcomes. Superficial resurfacing with non-ablative and ablative lasers may provide additional benefits in the treatment of fine lines and wrinkles, as well as signs of photodamage.

Upper Face

Maintenance of balance is a primary goal of upper face rejuvenation.

Primary goals of rejuvenation in this area are:

1. Maintenance and/or restoration of brow elevation. Loss of brow elevation is noticeable when the eyebrows descend below the level of the bony orbit (supraorbital ridge).
2. Reversing droop (ptosis) of the lateral brow. Drooping of the lateral brow is apparent as temporal hooding giving an overall appearance of fatigue and/or other negative expressions such as anger, sadness, or disapproval.
3. Restoring volume in the temporal area. Loss of volume in the temple area lateral to the tail of the eyebrow is associated with a drop in the tail of the brow.

Treatment Options: a combination of soft tissue fillers for volume restoration in the temporal area combined with non-surgical Botox®/Dysport® forehead lift. The combination of filler and Botox®/Dysport® may increase the longevity of the treatment outcome and provide a very desirable final result.

Mid Face

The most apparent effect of aging in the mid face is the loss of volume. Changes in the structure of and relationships between the inferior orbital rim and the upper maxilla (“mustache bone”) markedly influence facial appearance, including appearance of the eyes.

The most important treatment consideration is the degree of volume depletion and flattening that occurs in the malar area. The key to rejuvenating the mid facial area is volume restoration through reflation and re-contouring.

The specific treatment areas of interest are:

• lateral cheek (cheek bone, malar) projection
• under-eye dark circles (infraorbital hollow)
• tear though (nasojugal fold, medial arcus marginalis)
• nasolabial folds (NLFs)
• nasal dorsum
• nasal tip

Treatment Options: restoration of volume in the malar region with soft tissue fillers that results in an overall more youthful, rounded face with less sagging and reduced appearance of facial shadows and hallows.

Lower Face

Aging changes due to photodamage, loss of subcutaneous fat, gravitational changes and remodeling of the underlying bony and cartilaginous structures, which are particularly visible in the lips and surrounding tissues.

The appearance of the lower face is also modified by aging changes in the mid face. In addition, dentition changes, resorption of jaw (mandible) and maxillary bone, forward rotation and protrusion of the chin, and other aging changes alter the relative proportions of the lower third of the face to the upper two thirds. Gravitational changes result in sagging skin, jowls, and wattles as well. Repeated muscular contractions lead to furrows and lines that are superimposed on volume loss and exacerbated by loss of elasticity.

Primary goals of rejuvenation in lower face and neck are:

1. Lips – the lips tend to flatten and lose fullness with age
2. Outwardly radiating perioral lines, so called “lipstick lines”
3. Downward radiating lines, called “marionette lines”
4. Loss of definition occurs around the lower jaw (mandible) leading to a pebbled appearance of the chin “peau d’orange”
5. Horizontal (necklace) lines of the neck, and the longitudinal rope-like platysmal bands

Treatment Options: In treating the lower face, the primary goals are to restore volume with soft tissue fillers and reduce muscle mobility with Botox®/Dysport® injection. In addition, non-ablative and fractional ablative resurfacing is an invaluable tool in the treatment of fine superficial lines and wrinkles, especially lines around the lips. Lips that are the aesthetic focal point of the lower face deserve special attention. Filler materials can be effectively used to shape and volumize the lips.