In order to rejuvenate you, the patient, our new or old friend, we need to see what went wrong with your face. Faces are like snowflakes: they are all different. Basically, they can age in four ways which corresponds to four levels.
Some people will age in all 4 areas some mostly in 1 or 2. The significance of understanding this is that what might be a good procedure for your neighbor could be a waste of money and effort for you. As in the rest of medicine, establish the diagnosis and the appropriate treatment can readily follow.
#1 Starting on the surface the face can wrinkle or spot. This is all due to the sun ( actually this is the only part of facial aging which is due to the sun; the remainder is primarily genetic ). Wrinkles ( fine lines within the skin ) & spots/pigmentation are treated primarily these days with lasers, though very mild issues can be helped by chemical peels or even home skin care. Some lasers produce no downtime but for deep wrinkles a 7-10 day recovery is needed for substantial long lasting results.
#2 The next level below involves muscle plus skin - these are our expression lines: horizontal forehead lines frown lines, crow's feet, smile lines ( nose to corners of the mouth ), & marionette lines ( from the corners of the mouth to the sides of the chin ). These expression lines or furrows are treated with BOTOX or Dysport on the forehead & crow’s feet only & by injectable fillers like Restylane/Juvederm/Perlane/Radiesse/Artefill on the smile lines & marionette lines. Results are immediate: the so-called 'Wow' factor. No other transformation in cosmetic medicine produces an immediate result; it happens without any downtime.
#3 Looseness or laxity of skin yields in an advanced stage an obliteration of the sharp jawline seen in youth; in earlier stages merely looseness or the ability to stretch once tight skin is noted. The treatment for advanced looseness of the cheeks & neck is a facelift; the treatment for the earlier stages ( generally people up to 60- though many exceptions exist ) is Thermage, with which there is no downtime.
#4 Bone & fat loss or atrophy yields very large aging changes in the loss of fat in the cheeks & loss of bone in the lower jaw in females. These changes can be almost completely reversed with the use of fillers such as Radiesse, Sculptra, or Artefill.
In closing it can be noted that 2 elements contribute to one’s appearance at different stages of life: age & genetics. Indeed, there are elements in most 20 year old faces which might be improved upon with treatment if one so desired such as depressions/shadows under the eyes due to lack of fat, recessed chin, or lack of cheekbone definition; conversely we see from time to time in our office the miracle of a 70 year old face where genetics have trumped time. How sweet that is!
