Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Dynamic rhytids are wrinkles formed by the repetitive contraction of facial muscles. Common examples include glabellar lines (frown lines), horizontal forehead lines, and lateral canthal lines (crow’s feet). In youth, the skin snaps back after expression, but with age, these lines become etched into the skin.
The underlying cause is the hyperfunctional activity of the muscles of facial expression, combined with dermal elasticity loss. Over time, the skin loses its ability to recover from the folding caused by smiling, frowning, or squinting. Treatment focuses on relaxing the underlying musculature to prevent the skin from folding.
Volume loss is a hallmark of facial aging, leading to a gaunt or tired appearance. This deflation occurs primarily in the midface, temples, and perioral region. The deep fat pads, which provide the structural projection of the cheeks, atrophy and shrink over time.
This loss of deep support causes the overlying skin and superficial fat to slide downward and inward. The result is hollowing under the eyes (tear troughs), flattening of the cheeks, and the formation of deep nasolabial folds. Restoring this volume is essential for lifting the face and re-establishing youthful convexity.
The facial skeleton is not static; it undergoes significant resorption with age. The orbital apertures enlarge, the maxilla recedes, and the mandible loses height and definition. This loss of skeletal support contributes significantly to soft-tissue sagging.
A receding chin and jawline lead to the formation of jowls and the blunting of the neck angle. The widening of the eye sockets contributes to the appearance of under-eye bags and the descent of the brow. Non-surgical reconstruction often involves placing high-G-prime fillers deep in the bone to mimic skeletal support.
Photoaging refers to premature skin aging caused by chronic exposure to ultraviolet (UV) radiation. This manifests as dyschromia, or irregular pigmentation, including solar lentigines (sun spots), ephelides (freckles), and general blotchiness.
UV radiation damages the DNA of skin cells and degrades collagen and elastin fibers. This leads to a roughened texture, dilated blood vessels (telangiectasia), and a loss of luminosity. Treating photoaging requires modalities that target pigmentation and stimulate dermal repair mechanisms.
Skin laxity results from degradation of the extracellular matrix, specifically the elastin fibers that give the skin its snap-back quality. Elastosis refers to the accumulation of abnormal, disorganized elastin tissue, often caused by sun damage, which makes the skin appear thick, yellow, and leathery.
Laxity manifests as loose, crepey skin, particularly in the lower face, neck, and around the eyes. Gravitational forces act on this weakened skin envelope, causing it to sag and form folds. Energy-based treatments aim to heat the dermis, contract existing collagen, and stimulate the production of new, tighter fibers.
Many patients seek treatment because they feel they look tired even when well-rested. This phenotype is often caused by a combination of volume loss in the tear troughs, shadowing at the corners of the mouth, and brow descent.
Dark circles under the eyes are frequently a result of the shadowing caused by the loss of fat over the orbital rim. The downturned corners of the mouth (oral commissures) can create a sad or exhausted expression. Correcting these negative vectors helps align the patient’s appearance with their internal energy levels.
Uneven skin texture, enlarged pores, and acne scarring can compromise the face’s light-reflective properties, making it appear older and less healthy. Scarring from previous acne involves the tethering of the skin surface to deeper layers or the loss of collagen tissue.
Enlarged pores are often a result of the loss of perifollicular support; as the collagen around the pore weakens, the pore dilates. Resurfacing treatments aim to smooth the skin’s topography, remove the outer layer of dead cells, and stimulate dermal remodeling.
Gravity acts as a constant force on the facial tissues throughout life. However, its effects only become apparent once the retaining ligaments weaken and the skin loses its elasticity. The ligaments that tether the skin to the bone eventually stretch, allowing the soft tissue compartments to slide downward.
This gravitational descent creates the characteristic folds of the aging face, such as the nasolabial fold and the jowl. Non-surgical lifting aims to counter these forces by adding structural resistance through fillers or by tightening the skin envelope to hold the tissues in a more superior position.
Aging and environmental damage compromise the skin’s barrier function. The lipid barrier, which retains moisture and protects against irritants, becomes less efficient. This leads to chronic dryness, sensitivity, and a loss of the “glow” associated with healthy skin.
While often viewed as a cosmetic issue, a compromised barrier accelerates the aging process by allowing chronic low-grade inflammation (inflammaging) to damage the dermal matrix. Restorative treatments focus on improving hydration and fortifying the skin’s natural defenses.
Genetics plays a significant role in how and when the face ages. Some individuals are genetically predisposed to early volume loss, while others may be more prone to deep wrinkling or heavy sagging. The thickness of the skin, the strength of the bone structure, and the quality of the collagen are all heritable traits.
Understanding a patient’s genetic background helps formulate a preventive treatment plan. For example, a patient with a family history of deep jowling may benefit from earlier intervention with skin tightening technologies to delay the onset of these traits.
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Hollow eyes, or tear troughs, are typically caused by the loss of the fat pad that sits just under the skin and muscle of the lower eyelid, combined with the thinning of the skin itself. This creates a dark circular shadow.
Yes, a gummy smile is often caused by a hyperactive muscle that pulls the upper lip up too high when you smile. A small amount of neuromodulator injected into this muscle can relax it, allowing the lip to rest lower and cover the gums.
Marionette lines run from the corners of the mouth down to the chin. They are caused by the descent of the cheek fat pads and the loss of volume in the chin and jawline, which allows the skin to fold over the ligament at the corner of the mouth.
Fractionated CO2 laser resurfacing typically involves a social downtime of 7 to 10 days. During this time, the skin will be red, peeling, and healing. Full redness may take a few weeks to fade completely, but it can usually be covered with makeup after the first week.
Crepey skin on the neck is primarily due to the loss of collagen and elastin, often accelerated by sun damage since the neck is frequently exposed. The skin becomes thin and loses its ability to snap back, resulting in a crinkled texture.
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