THE FACIAL AGING PROCESS
The changes associated with aging do not occur all at once - they happen in a slow or not
easily apparent manner and involve several components of the face.
The skull actually becomes thinner and smaller, thereby causing the overlying tissues,
particularly the area of the face, to be in excess. This phenomenon, along with simultaneous
loss of skin elasticity, results in the deepening of the lines of expression in the forehead
and at the sides of the mouth. Sagging of the outer part of the eyebrows, so that the eyes
appear small and "crow feet" form, the development of pouches along the jawline, and, of course
the well known "double chin" all become evident.
At the same time degenerative changes occur in the outer layer of the skin itself
so that it seems to "look tired", but more important, some faces become etched with numerous
fine wrinkles in addition to sagging. Fig 15.
The muscles around the eyes often weaken so that fat herniates through them to produce the
commonly seen 'bags' or pouches, giving a tired and aged appearance. Part of the fat of the
face is absorbed and the remainder begins to hang down unevenly and loosely due to the effects
of gravity. Finally, and some people are seldom aware of this, the tip of the nose drops
causing it to appear larger and longer.
It can be seen, therefore, that each individual presents a different problem or set of
problems, and consequently, the corrective procedures indicated vary with the case. For
example, one person may require only elevation of sagging eyebrows or improvement in the
eyelids; a very young individual may need only correction of an early double chin or a
change in a 'tired and sad' facial expression by forehead and eyebrow correction. On the
other hand, a partial or complete face and neck lift may be called for. Finally, when the
skin is weatherbeaten in appearance, it cannot be improved enough unless a chemical peel
or laser resurfacing is done. Fig. 15e,f.
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