The face, the most expressive part of our body, is also the most exposed to environmental factors, and therefore ages faster than the rest of the body. The facial aging process can be divided into two broad categories: photoaging/textural aging and structural aging. As a result of photoaging, brown age spots (liver spots) and coarse wrinkles develop on sun-exposed areas. On the other hand, with structural aging, the face shape and facial proportions change. For best results, both environmentally induced and age-associated structural changes should be addressed simultaneously.

Age-associated changes in the skin

Dermal Thinning and Loss of Elasticity

There are many factors associated with the reduction in collagen and elastin that can lead to clinically visible fine lines and wrinkles. Among them are: photoaging (related to sun exposure); exposure to UVA, UVB, and infrared sun radiation; chronological aging; smoking; and exposure to environmental pollutants.

Therapy Options

Sun protection, cessation of smoking, healthy diet, and an appropriate skin care regimen with topical retinoids are cornerstones of the therapy. Other beneficial procedures include chemical peels, microdermabrasion, intense and pulsed light (IPL), BroadBand Light (BBL), photodynamic therapy (PDT), and non-ablative and ablative lasers.

Dr. Reszko’s Tip: More aggressive laser treatments are usually associated with increased downtime, but offer greater clinical benefit with fewer treatments.

Textural Irregularities

Benign and premalignant and malignant growths, acne scars, dilated pores, and enlarged oil (sebaceous) glands may give the skin irregular texture and a less desirable appearance.

Therapy Options include: surgical removal of growths, chemical peel, microdermabrasion, non-ablative and ablative lasers.

Dr. Reszko’s Tip: Consult a physician prior to the removal of any skin lesion. Superficial melanoma may camouflage as a skin freckle, and basal cell carcinoma may be easily mistaken for a benign mole, proliferation of sebaceous glands or even a skin tag.

Pigmentary Changes

A youthful face demonstrates uniform pigmentation. Photoaging results in the appearance of freckles, sunspots, and melasma or other darkened patches. In addition, photoaging can contribute to the development of prominent blood vessels visible on the surface of the skin and vascular lesions, appearing as tiny blood-filled blisters, or even a constant flush of facial redness.

Therapy Options: Sun protection and an appropriate skin care regimen with topical retinoids are key. Other beneficial procedures include chemical peel, microdermabrasion, IPL, BBL, vascular (PDL) and pigment targeting lasers (Q- switched NdYAG), photodynamic therapy (PDT), non-ablative and ablative lasers, resurfacing lasers.

Gravitational Aging

This leads to the drooping of the skin, manifesting in the development of lines, grooves, wrinkles, and jowls (“lines, sags, and bags”).

Therapy Options: botulinum products (BOTOX®, Dysport®, Xeomin®), fillers, neck and jowl liposuction, contour thread lift, S-lift, blepharoplasty, facial implants, brow-lift, ablative CO2 and erbium: YAG laser resurfacing, skin tightening technologies (Thermage®, Ultherapy®).

Volumetric Aging

Facial volume loss combines with inelastic, aging skin that is unable to accommodate underlying structural changes, leading to the look of a “deflated balloon.” This leads to the development of deep lines, hollows, furrows, and thinning of the face. The loss and redistribution of fat in the temples results in the loss of natural convexity of the area. Loss of lateral and mid-face cheek fat leads to sagging and soft tissue loss in the mid face. Bone remodeling also plays a role. Decreased lateral brow support leads to sagging eyebrows, sunken maxilla (upper jaw) and deepening of nasolabial folds (“laugh lines”).

Therapy Options: fillers, own (“autologous”) fat transfer, facial implants.