Skip to main content

Abstract

The face does not age as one homogeneous object, but as a result of several dynamic components. Changes that occur with facial aging involve a complex interaction among the bone, skin, soft tissue, support ligaments, and septa. Facial aging is a multifactorial process. To properly restore the youthful facial appearance, it is essential to understand the facial morphological changes over time. A balanced approach to facial rejuvenation between bone and fat volume augmentation and soft tissue envelope repositioning will avoid the distortions of either approach in isolation. Skeletal resorption can be improved with calcium hydroxyapatite injections or implants. The loss of volume in fat compartments can be restored with fillers or fat grafting in specific deflated fat compartments. The SMAS, the retaining ligaments, and the lid structures can be modified with surgery. Botulinum toxin is useful to reduce the increased muscular resting tone present in aging. Skin rejuvenation can be performed with retinoids, laser resurfacing, and peels. To achieve an integral rejuvenation, we should individualize the treatments and perform them step by step.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Farkas JP, Pessa JE, Hubbard B, Rohrich RJ. The science and theory behind facial aging. Plast Reconstr Surg Glob Open. 2013;1(1):e8–e15.

    Article  Google Scholar 

  2. Varani J, Spearman D, Perone P, et al. Inhibition of type I procollagen synthesis by damaged collagen in photoaged skin and by collagenase-degraded collagen in vitro. Am J Pathol. 2001;158:931–42.

    Article  CAS  Google Scholar 

  3. Pessa JE, Nguyen H, John GB, et al. The anatomical basis for wrinkles. Aesthet Surg J. 2014;34(2):227–34.

    Article  Google Scholar 

  4. Fitzgerald R, Graivier MH, Kane M, Lorenc ZP, et al. Update on facial aging. Aesthet Surg J. 2010;30(Suppl):11S–24S.

    Article  Google Scholar 

  5. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27.

    Article  CAS  Google Scholar 

  6. Schaverien MV, Pessa JE, Rohrich RJ. Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg. 2009;123:695–700.

    Article  CAS  Google Scholar 

  7. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. 1992;89:441–9; discussion 450–451

    Article  CAS  Google Scholar 

  8. Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg. 2000;26:1107–12.

    Article  CAS  Google Scholar 

  9. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg. 2007;120:1367–76. discussion 1377

    Article  CAS  Google Scholar 

  10. Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. 2008;121:2107–12.

    Article  CAS  Google Scholar 

  11. Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg. 2008;121:1804–9.

    Article  CAS  Google Scholar 

  12. Rohrich RJ, Arbique GM, Wong C, et al. The anatomy of suborbicularis fat: implications for periorbital rejuvenation. Plast Reconstr Surg. 2009;124:946–51.

    Article  CAS  Google Scholar 

  13. Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg. 2009;124:266–71.

    Article  CAS  Google Scholar 

  14. Wan D, Amirlak B, Rohrich R, Davis K. The clinical importance of the fat compartments in midfacial aging. Plast Reconstr Surg Glob Open. 2013;1:e92.

    Article  Google Scholar 

  15. Gierloff M, Stöhring C, Buder T, et al. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012;129:263–73.

    Article  CAS  Google Scholar 

  16. Gosain AK, Klein MH, Sudhakar PV, et al. A volumetric analysis of soft-tissue changes in the aging midface using high resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg. 2005;115:1143–52; discussion 1153–1155

    Article  CAS  Google Scholar 

  17. Wan D, Amirlak B, Giessler P, Rasko Y, et al. The differing adipocyte morphologies of deep versus superficial midfacial fat compartments: a cadaveric study. Plast Reconstr Surg. 2014;133(5):615e–22e.

    Article  CAS  Google Scholar 

  18. Ramanadham SR, Rohrich RJ. Newer understanding of specific anatomic targets in the aging face as applied to injectables: superficial and deep facial fat compartments--an evolving target for site-specific facial augmentation. Plast Reconstr Surg. 2015;136(5 Suppl):49S–55S.

    Article  CAS  Google Scholar 

  19. Le Louarn CL, Buthiau D, Buis J. Structural aging: the facial recurve concept. Aesthet Plast Surg. 2007;31:213–8.

    Article  Google Scholar 

  20. Cotofana S, Fratila AA, Schenck TL, Redka-Swoboda W, et al. The anatomy of the aging face: a review. Facial Plast Surg. 2016;32(3):253–60.

    Article  CAS  Google Scholar 

  21. Wong CH, Mendelson B. Newer understanding of specific anatomic targets in the aging face as applied to injectables: aging changes in the craniofacial skeleton and facial ligaments. Plast Reconstr Surg. 2015;136(5 Suppl):44S–8S.

    Article  CAS  Google Scholar 

  22. Brandt MG, Hassa A, Roth K, et al. Biomechanical properties of the facial retaining ligaments. Arch Facial Plast Surg. 2012;14:289–94.

    PubMed  Google Scholar 

  23. Shaw RB Jr, Katzel EB, Koltz PF, et al. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr Surg. 2011;127(1):374–83.

    Article  CAS  Google Scholar 

  24. Pessa JE. An algorithm of facial aging: verification of Lambros's theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg. 2000;106(2):479–88; discussion 489-90

    Article  CAS  Google Scholar 

  25. Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg. 2012;36(4):753–60.

    Article  Google Scholar 

  26. Kahn DM, Shaw RB Jr. Aging of the bony orbit: a three-dimensional computed tomographic study. Aesthet Surg J. 2008;28(3):258–64.

    Article  Google Scholar 

  27. Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthet Plast Surg. 2007;31(5):419–23.

    Article  Google Scholar 

  28. Pessa JE, Zadoo VP, Yuan C, et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg. 1999;103:635–44.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Guisantes, E. (2019). Beauty and Aging. In: Pinto, H., Fontdevila, J. (eds) Regenerative Medicine Procedures for Aesthetic Physicians. Springer, Cham. https://doi.org/10.1007/978-3-030-15458-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-15458-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15457-8

  • Online ISBN: 978-3-030-15458-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics