Here’s a challenge: find a photo of yourself from 10 years ago, and compare it to your face now. Most likely, you’ll notice your face used to be fuller, and there was significantly less shadowing compared to today. These shadows are due to the decrease in volume of your face and the underlying bony structural changes that have occurred under your skin. If you’re older than fifty, you may notice the shape of your face looks less heart shaped and more square shaped.
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When we meet someone, we often make an immediate impression using the right side of our brain. This “blink” response, as described by Malcolm Gladwell, is an important concept in facial plastic surgery, because we make an almost immediate impression about whether someone looks older, younger, better, or worse.
So what exactly happens as we age? Aging is the result of many changes occurring with the facial muscles, skeleton, fat, and skin. These changes occur at different ages and speeds for each person. Below are a few (simplified) characteristics of the aging face.
- Sagging skin
- Increased number and depth of fine wrinkles
- Loss of volume, structure, and support
- Segmented shadows across the face
- Increased pigmentation and dullness of skin
- Volume shift from upper to lower face
Rembrandt was, in fact, fascinated by the aging face. From 1626 until his death in 1669, he created over 90 sketches and paintings incorporating his own face. Top left: Self-Portrait with Gorget (1629), age 23. Top right: Self-Portrait with Beret (1640), age 34. Bottom left: Self-Portrait with Beret (1655), Age 49. Bottom right: Self-Portrait (1659), age 53. (courtesy of thesmartset.com)
In order to achieve a natural appearance with fillers, I use the principles of aging and the concept of blink impressions to approach surgical and nonsurgical procedures of the face. Volume should not be the goal, but rather a technique used to achieve a desired aesthetic endpoint. When volume is added haphazardly, the results are often unnatural and bizarre. Sometimes, sagging skin is the primary concern, and surgical correction offers the best and most durable results. The key is identifying specific areas that could benefit from cosmetic enhancements, and then artistically and meticulously addressing those areas.
To minimize signs of aging, I recommend using sunscreen daily, regular exercise, a healthy diet, a tailored skin care regimen, considering Botox and fillers, and incorporating facial plastic surgery in a gradual, stepwise fashion. For a natural, subtle look, opt for a series of smaller changes over time, rather than a massive overhaul after decades of neglect.
