The lower eyelid complex undergoes similar changes as the upper eyelid with excess/loose skin formation and bulging of the fat behind it. In addition to those changes, the lower eyelid can droop leading to increased scleral show (the white of the eye) and/or rounding of the lateral eyelid region. These changes contribute to the tired appearance of the aging patient. An additional deformity eventually forms called the tear trough deformity, which is the result of the cheek (malar) fat descending along with the aforementioned changes of the lower lid. This deformity can easily be treated with fat grafting or injectable fillers, such as Restylane® or Juvederm® while the other problems are easily addressed with a lower eyelid lift (blepharoplasty).
The cheek (malar) fat pad in a youthful patient is full and superiorly positioned in the face. As mentioned previously, with aging there is fat atrophy and descent of the tissues. The face is unique as it has a ligamentous system suspending the soft tissues. . Throughout our lives and the aging process, these ligaments stretch and loosen with time contributing to soft tissue descent. As the soft tissues descend, patients see formation of deep nasolabial folds and jowling. These issues are specifically addressed with fat grafting, facial implants, injectable fillers or face-lifting techniques in addition to treating the skin with laser and/or chemical resurfacing.
Jowling as mentioned above is a result of soft tissue descent and ligamentous laxity. The youthful lower face possesses a well-defined mandibular border, which becomes obscured in the aged face. As mentioned before, this deformity is easily addressed with face-lifting techniques modifying the deeper tissues of the face, not just the skin, as many surgeons like to do. The perioral region (around the mouth) is a key player in the aged look of the lower face as the corners of the mouth turn downward from cheek ptosis(descent), compounded by loss of vertical height from tooth loss/attrition. Patients develop marionette lines (“drool lines”) lateral to the mouth along with thinning of the lips. These deformities are easily treated in the office under Local or topical anesthesia with fat grafting or injectable fillers.
A very common complaint heard from older aging patients is “I hate my neck”. Patient’s hate the excess and loose skin which accumulates in their neck as they age. The youthful neck is sculpted and well defined with a perfectly contoured jaw line. With aging there is a loss of definition of the cervicomental angle leading to a poor jaw line, fat atrophy over the chin and fullness of the submental area (fat under the chin). Banding of the platysma muscle can also occur with resultant vertical “bands” in the neck. Rejuvenation of isolated neck deformities involves a cervicoplasty/plastysmaplasty, however, most patients that have neck deformities also have mid-face deformities and would benefit most from a proper face and neck lift.
While addressing each area of the face individually above, patients should be aware that any of these surgical procedures can be done alone or in combination with others to address each person’s issues or concerns about their face and neck. The face and neck should be cared for from a young age with good skin care products, sun avoidance, and a healthy lifestyle in order to avoid early aging. But with time, atmospheric pollutants, genetic make-up and lifestyle, aging is inevitable for all of us. Injectables and skin care can maintain a youthful appearance for some time. Surgical procedures can be done individually as each issue arises or as combination procedures based on need. Most importantly, when investing in yourself and your appearance with Plastic Surgery, trust your face to a properly credentialed plastic surgeon and his staff.
Contact us today to schedule your consultation with plastic surgeon Nathan Eberle, M.D., D.D.S. at the Weston Center for Plastic Surgery.