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The face is the focal point of human beauty. Although various factors influence facial beauty, the aging process is the most common aspect prompting non-surgical and/or surgical intervention. Aging is a dynamic and continual process. Different cultural, ethnic, and gender norms (Table 1.1) of beauty exist; however, there are certain features which globally transcend these differences to determine what is perceptually pleasing. Heredity and environmental factors (eg, sun exposure, wind, trauma) are the main determinants of aging. In addition, cigarette smoking and estrogen loss can accelerate the aging process. As one ages, changes can be observed in all facial and non-facial anatomical compartments, including the skin, subcutaneous fat, muscle, and bony structure. Use of a systematic approach in the analysis of facial and non-facial aging will allow for the selection of appropriate, safe, and effective therapies.

TABLE 1.1Facial Age-Related Contour Changes


Successful rejuvenation of the face and non-facial regions requires a thorough understanding of age-related contour changes (underlying soft tissue aging) and textural changes (skin aging) (Tables 1.1 and 1.2).

TABLE 1.2Age-Related Textural Changes

A youthful face can be divided into three facial zones: upper, middle, and lower zones, as well as the upper neck.

The upper face includes the forehead, temple, and periorbital region. Aging results in flattening of the brow arch, eyelid skin redundancy, pseudo fat herniation, and formation of dynamic rhytides at the lateral canthus. Horizontal forehead skin creases develop secondary to sustained contraction of the frontalis muscle in a subconscious attempt to elevate the sagging brows. A rim sulcus deformity develops between the cheek and the eyelid with upper cheek thinning. This sulcus is exacerbated by a preexisting tear trough deformity. Orbicularis oculi muscle ptosis can create a malar fullness, referred to as a malar crescent.

The midface includes the cheekbones that form a smooth continuous convexity from the eyelid to the lip. The melolabial fold represents a flat, smooth junction between the lower cheek and the upper lip. The aging face results in a downward migration of the malar soft tissue, accentuating skeletonization of the orbital rim. Central cheek fat ptosis creates a fullness lateral to the melolabial fold, referred to as nasolabial folds.

The lower face possesses a well-defined mandibular border and a well-defined cervicomental angle. With aging, platysmal muscle ptosis and cheek fat ptosis along the mandible produce “jowls” overlying the jawline. Soft tissue atrophy anterior to the jowls creates a “prejowl sulcus” which ...

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