Dr. Lindsey's Newsletter #30: Plastic Surgery by Decade - 60s: Slip Slidin' Away

60s: Slip Slidin’ Away

My goal for this edition is to teach you about the natural process of facial aging. Over time the face and neck slip downward with gravity in a relatively predictable fashion. Your anatomy, genetics, environmental exposures, and lifestyle will dictate how your face and neck age but the core principles of facial aging remain the same. I want to better equip you with an understanding of facial aging so that you can make an informed decision about facial rejuvenation surgery with your plastic surgeon. 

Uneven Skin Tone and Texture:

Your skin accumulates damage from the environment each day that you are alive and this results in uneven pigmentation and texture. These changes are the result of cumulative sun exposure, smoking, hydration status, weight changes, environmental damage, natural fluctuations in hormone levels, and gravity. Age spots are a hallmark feature of facial aging.

Wrinkles and Fine Lines:

One of the most surface level signs of aging is the appearance of wrinkles and fine lines on the face. These develop gradually over time due to the loss of collagen and elastin, which are proteins responsible for keeping the skin firm and elastic. I like to call this the Spanx of your skin, and with time it gets stretched out. Wrinkles typically form in places where you have the most muscle movement. Crows feet form when you squint your eyes and your orbicularis oculi muscle pulls on the skin in a radial pattern. Transverse forehead wrinkles form when you raise your eyebrows and your frontalis muscle pulls on the skin perpendicular to the wrinkle line. Your eleven lines form when you focus or scowl and your corrugator muscles pull your brows together and down. Smoker’s lines form, not just from smoking, but from constant use of your lip muscles as you open and close them with your orbicularis oris muscle.  

Wrinkles and fine lines can be exacerbated by factors such as sun exposure, smoking, and repetitive facial expressions. I recently discovered a blog online describing facial yoga exercises meant to prevent/reverse aging. The blog described repetitive facial expressions with a promise to restore youth with improved appearance of the face. I bring this up to illustrate the point that, repeated facial expressions create wrinkles. This is the entire principle upon which tox injections work. Freeze the muscle with tox, paralysis prevents expression, failure to express prevents the wrinkle from forming. Skip the facial yoga, it’s the only kind of yoga that isn’t good for you.

Loss of Facial Volume:

As we age, the fat pads beneath the skin diminish in volume, leading to a loss of facial fullness and definition. This can result in hollowed cheeks, sunken temples, and a less defined jawline. Additionally, the bones of the face may lose volume, contributing to a loss of structural support and further accentuating signs of aging.

Sagging Skin and Glands:

Perhaps the most aggravating feature of facial aging is the gradual loosening and sagging of the skin. This occurs as a result of decreased collagen production, reduced skin elasticity, and the effects of gravity over time. Sagging skin can lead to eyebrows drooping below your brow bone, upper and lower eyelid drooping, cheeks drooping on top of accentuated nasolabial folds, and the formation of jowls as the skin slides down the face. Jowls are even further accentuated by the volume loss of fat and bone along the jaw slowly decreasing over time. The glands in your face and neck can also enlarge, sag, or become more visible as their appearance is more visible behind the stretched out Spanx of your supporting anatomy. 

Dr. Val Lambros performed a study on facial aging and produced 3D models of the face which represent the average person at two timepoints, 33 years and 70 years old.  In the image below you will note the eyes squint closed with time, the nose enlarges, the upper lip lengthens and thins, and the jawline is no longer smooth.

The oblique angle better shows the jowl formation from a combination of skin sagging plus volume loss of the bone and soft tissue around the jowls. 

Addressing Facial Aging:

While we cannot stop the clock from marching forward, there are various treatments and strategies available to make obvious features of aging optional. Through preventive measures and carefully curated surgical treatments we can optimize the aging process. Surgery is the most powerful and natural appearing means of reversing the clock. There is no tool more precise than surgery offers. There is certainly a place for non-surgical interventions like tox injections, fillers, laser resurfacing, and more. The key is to have a plastic surgeon guiding your treatment plan so that you know how to best budget your resources. When the answer is surgery, there is no other means that can achieve a surgical result. You have probably heard the saying “abs are made in the kitchen”, well in a similar way your surgical outcome is a direct reflection of your own lifestyle choices. Adopting a healthy lifestyle, protecting the skin from sun damage, and following a consistent skincare routine will set you up for surgical success when the time comes. 

I hope this overview of facial aging helped you understand the changes you may be noticing in the mirror. Moving forward we will explore different parts of the face in detail, review features of aging, and discuss surgical options. If you are in need of a comprehensive anti-aging treatment plan I would be happy to evaluate you in a private consultation for facial aging. This consultation will include a facial analysis, skincare recommendations, non-surgical recommendations, and evaluation for surgery needs. Call my office and ask for a “facial aging” consultation with me and together we can make aging optional.

As always, here's to choosing how we age, on our own terms!