Cosmetic Medicine by Dr Eddie Roos

COSMETIC MEDICINE
STRUCTURAL CHANGES
Shrinking of facial bones also plays a role in ageing the face. Evidently, facial
bones remodel their three-dimensional shape with age, showing the most
pronounced difference measured in the T-zone. In women, the area between the
brows and top of the nose (the glabellar angle) is shown to decrease as the area
under the rim of the eyebrows retreats, resulting in sagging brows and deflated
eyelid skin. In men, the glabellar angle decreases and the area supporting the
cheeks (maxillary angle) is also shown to decrease.
Additionally, the malar fat pad, which is responsible for cheek fullness, slides
down and forward, pushing against the nasolabial fold and making the maxillary
angle appear more pronounced. Bones can also recede in the pyriform angle
(the opening of the nose), causing the appearance of an elongated nose and a
drooping nasal tip.
‘Extrinsic factors
often act
together with
the normal
ageing process
to prematurely
age skin’
LOSS OF VOLUME
Facial ageing is reflective of dynamic and cumulative effects of time on the skin,
soft tissues and deep structural components of the face. It is a complex synergy of
skin textural changes and loss of facial volume. Many of the facial manifestations
of ageing combine the effects of gravity, progressive bone resorption, decrease
in tissue elasticity and redistribution of subcutaneous fullness.
With age, facial fat descends and causes the shape of the face to change.
The youthful face is typified by full, well-supported fat, and surrounding ligaments
serve to fixate this volume of fat to underlying structure. Together with the
volumetric fullness of the upper cheek region are well-defined contours such as
a smooth S-shaped curve (commonly called the Ogee curve) of the cheeks when
seen from an oblique angle and a clean neck/chin angle and jaw line. It is this
pairing of both fullness and facial definition that accounts for the more tapered
appearance of the youthful face.
As this ligament support reduces, facial fat volumetrically comes forward and
descends in the cheek, producing a squarer facial contour with less distinction
between upper cheek volume and mid-facial fat. This lowering of the facial fat
means that over time the face appears vertically longer than young faces.
Facial fat also deflates with age and this is most apparent in regions with a
high density of retaining ligaments, which are typically volumetrically full in youth
(malar, preparotid, lateral and infraorbital rim, and lateral chin). Along with facial
deflation comes a laxity in soft tissue caused by diminished support.
RADIAL EXPRESSION
Facial ageing is not all vertical – the soft tissue that occurs along specific areas
of the mid-face also undergoes radial expansion. The skin and underlying
subcutaneous fat are densely attached to the deep facial fascia by retinacular
fibres that weave in the skin, subcutaneous fat, superficial and deep fascia
and muscle.
For example, over time facial expressions cause the skin along the nasolabial
line to disrupt the subcutaneous fat, disengaging these attachments and
developing lines of differentiation on the face. This forces the skin and fat
alongside the nasolabial fold to expand radially and fall out from the skeleton,
explaining some of the nasolabial fold prominence in the ageing face.
Radial expansion lateral to the marionette lines extending from the corners
of the mouth downwards also accounts for some of the jowling that becomes
apparent with age.
DR EDDIE ROOS WWW.COSMETICELEGANCE.COM.AU // 9