The Aging Face & Creating a FacePlan

Plastic Surgery Options may be the optimal choice for those who want to feel as youthful on the outside as they do on the inside. Dallas-based Board-Certified plastic surgeon, Ramsey J. Choucair, M.D. presents his viewpoint. 

We all experience the aging process in varying degrees and individual rates. Perhaps the most prominent area of aging is the face. The aging face is visually apparent to others and greets us each day in the morning mirror. The aging process of other parts of the body are more easily hidden or overlooked, however, the passage of time is noticeably evident around the eyes, jawline and neck, often reflecting an outward weariness. This external appearance, occasionally portraying diminished vitality, often misrepresents an otherwise energetic individual. This incongruous reality frequently motivates people to seek options to restore a more youthful look that more accurately mirrors their youthful spirit.

To this end, the first step in making treatment recommendations is to determine the specific characteristics associated with the facial aging process. Although similarities exist, treatment must be tailored to each person as “one size does not fit all”

We examine three aspects of the aging face to create a “FACEPLAN” for each individual. 1. Surface Skin Quality 2. Facial Volume 3. Skin Laxity

1. Skin Quality- First we evaluate the skin quality, including the surface texture, pore size, pigment appearance and potential damage from years of sun exposure. Genetic influences and distinct skin types contribute heavily to skin elasticity and the rapidity of aging. Youthful skin is typically devoid of irregular pigment, scaly patches, broken blood vessels and a sallow hue.

2. Facial Volume- Youthful faces are full. The normal fatty layer of youth provides facial volume, resulting in a smooth, soft, and gentle shape. With aging, facial volume is diminished, leading to skin folds, hollow contours and visibility of the facial bones, especially around the eyes.

3. Skin Laxity- The youthful face is characterized by a taut jawline, firm neck skin, and smooth skin surrounding the eyes. Jowl prominence, sagging neck skin, and droopy eyelid and eyebrow skin are hallmarks of the aging face. These three primary factors–skin surface quality, facial volume and skin laxity, all converge to paint the picture of individual facial aging. Armed with this information, an experienced plastic surgeon will formulate the best treatment plan to restore a level of youthfulness based on each patientʼs desires and expectations.

An overview of the treatment options used in the FACEPLAN are as follows:  

  • Surface skin treatment recommendations may include microneedling, laser modalities, chemical peels, microdermabrasion, physician-directed skin care (ie Retin-A, bleaching creams) and regular maintenance with facials.
  • Facial volume may be restored with hyaluronic acid, “off-the-shelf” injectable fillers such as the family of Restylane and Juvederm products. Fat injection is often recommended for filling the deflated, aging face.
  • Finally, skin laxity is best managed with lifting procedures such as a lower face and neck lift or eyelid surgery to reposition sagging, droopy skin. Although these suggestions are surgical procedures, the attempt to achieve rejuvenation by pushing beyond the aesthetic limits of injectable fillers and non-surgical options often results in overinflated appearances that are first and foremost, errors in judgment.

The first step in reversing the facial aging process is to seek the advice from a surgeon well versed in all the techniques mentioned above. Practitioners capable of addressing all aspects of facial aging can provide the most comprehensive assessment and treatment recommendations. More importantly, patients should obtain more than one opinion and proceed only after confirming that their expectations are reasonable and achievable. Remember, you are relying on the JUDGEMENT of the physician as the most important ingredient for a successful outcome.

Lastly, facial aging is inevitable and a NORMAL phenomenon. Aging gracefully is appropriate and we should all embrace it with the spirit of acceptance. By the same token, some individuals desire to age gracefully but at a slower pace! And thatʼs ok too! For persons desiring facial rejuvenation, rest assured that the outlandish, media driven, reality shows and distorted characterization of plastic surgery is farthest from “reality”. You only notice the less than optimum, overdone appearances that grab all the attention. What you fail to notice is the natural look of someone sitting next to you at dinner who looks more youthful than expected for his or her age. Those are the norms for patients treated by dedicated and experienced surgeons employing good judgement and reasonable standards.