The Ageing Face

I am sure by now we are all too familiar with this simple fact: the face changes as you age. This not only happens as a result of ageing skin and wrinkles, but also due to changes in bone structure. One cause of this ‘change’ is bone resorption, which results in areas supported by bone (such as your cheeks and jaw line) appearing less defined. Other contributing factors are the loss of fat pads on the face and reducing levels of hyaluronic acid to plump out the skin. All fun and games, eh?

If you are not quite ready to embrace the inevitable changes nature (quite literally) throws in your face, then fear not: there are options. This informative article could help you decide which of the many anti-ageing treatments currently on the market is for you.

When you are considering a treatment, and new to the world of aesthetic medicine, it is very difficult to determine which of them are most suitable to your needs. Some people can prematurely decide they only want to have a dermal filler with no muscle relaxing injections (or vice versa) before seeing a practitioner for a consultation, assessment and advice, or really understanding these treatments at all.

I have therefore decided to provide you with some very simple guidance on the correct and appropriate use of both dermal fillers and Botulinum toxin type A. As a wise old pal once said:

“If you can’t explain it simply, you don’t know it well enough”

-Albert Einstein

Injectable Treatments

Dermal fillers are generally Hyaluronic acid (HA) gels. HA is naturally present in your skin and joints but it depletes as you get older.

Muscle relaxing injections are Botulinum toxin type A – this injection blocks the signal from nerves to muscles so that the muscle is no longer able to contract (thus, relaxing it).

Muscle Relaxing Injections

Lines and wrinkles caused by muscles contracting are called Dynamic lines. These lines occur anywhere the face moves and creases. Botulinum toxin is the most effective way to treat these as it relaxes the muscles that have caused the wrinkles causing them to soften. This treatment is most commonly used on the upper area of the face where lines form due to facial expressions such as frowning, smiling and raising the eyebrows. The treatment can also be used in the lower face; however, much more cautiously as these muscles are functional as well as expressive. For example, we use our mouth to smile, but also to talk, drink and eat, meaning muscles around the mouth cannot be relaxed in the same way. Tiny doses can be used to soften lines around the lips (sometimes called smokers lines) but these are not advisable if you play a wind instrument as the ability to purse your lips is reduced (I heard a story once about a life guard who could no longer blow his whistle. I wouldn’t want your dreams to be crushed this way.)

This treatment is also effective if you are starting to have a permanently sad appearance due to a downward turned mouth, or likewise for a gummy smile if you have very strong muscles pulling up your top lip and therefore exposing your gums. Moreover, I have used this treatment very effectively to enhance a smile’s asymmetry when muscles are much stronger on one side than the other. Similarly, injections can be placed in a strong jaw to soften it, and in neck muscles as they become stiff and prominent with age. All treatments in the lower face are considered advanced techniques. An in depth understanding of anatomy is essential to ensure the correct muscles are treated and at the correct doses.

Hyaluronic Acid (HA) Fillers

HA fillers restore volume loss. They are a soft gel that helps to plump up the skin. They come in different thicknesses and are injected in to the skin at varying depths depending on the area injected. They get absorbed in to your own tissue, attracting water, and give a lovely hydrated lift to the skin. These can be used in the upper face where lines are still visible after being treated with muscle relaxing injections, and to give lift to the skin in areas that have become hollow, such as the temples and tear troughs. Soft filler can be placed under the skin to help soften remaining fine lines and hydrate the skin.

Volume loss occurs in the mid face and skin can start to sag. HA fillers can be placed deep under the skin to restore this loss, define cheek bones and help lift sagging skin. This will also help with the lines/folds that form from your nose to your mouth when smiling. HA filler can also be placed under these lines to help soften and lift them.

‘Sleep lines’ are another common cause of wrinkled skin. Unless you sleep on your back all night like sleeping beauty (I have tried this but still persistently wake up with my face scrunched up in to a pillow), then creases can form on the side of your face that you sleep on. These ‘sleep lines’ can be lifted and smoothed with filler. Lines around the mouth (smokers lines), the lines from the corners of your mouth making you look sad, and of course the lips themselves can all be treated with HA fillers. Lips can be hydrated with soft filler or given more volume with thicker filler. They can also be used to help redefine the jaw line. They can either be injected with a needle or a cannula depending on the area and desired effect. Alas, an in depth knowledge is essential for correct and safe placement of filler, especially in areas that are considered to be high risk due to facial arteries and nerves.

When my clients are seeking treatment but aren’t sure where to start, I ask them what bothers them the most when they look in the mirror and what they consistently dislike in photographs. It often transpires that people have something that they zone in on when looking at themselves. I therefore assess their face as a whole and make suggestions for a treatment plan that will target the specified areas whilst keeping the face balanced.

It is important to ensure that the face remains in harmony. You want people to notice a change in the sense that you look particularly ‘well’, not stare quizzically at your features trying to pinpoint exactly what’s happened.

Look out for more informative articles on medical aesthetic treatments on my page. If there is anything in particular you would like to know more about, then please do get in touch:

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