My Current Typical Approach to the Aging Face

Session Description

My Current Approach to the Aging Face has nothing typical about it. The way the aging face is approached is complex , individualized  and multifaceted. It must consider the intrinsic and extrinsic influences on aging as well as the heritable features that form the foundation in the given individual. The nuts and bolts are surface, subsurface and foundation or skin quality and condition, subcutaneous fat, deep fat and muscle and the skeleton. All issues may need to be addressed for the greatest most natural appearing rejuvenation. In designing recommendations for the individual the skin is probable the most variable dependent on heritage, environmental injury and patient capacity. We are primarily addressing wrinkles or pigment and what restricts our approach to the individual. First would be their tolerance of the process. If they can not participate in complex postoperative wound care then non-ablative maneuvers must be used.  Modest gains can be made with IPL(intense pulsed light) and BBL (broad band light) treatments. These are more reliable in addressing pigment issues than some of the lighter peels and when partnered with micro-needling, fraxel or ICON 1540 can improve fine lines. To truly improve the etched wrinkles to a significant degree ablative resurfacing must be considered. I have chosen to rely on Fractionated CO2 laser over deep peels and dermabrasion primarily because of the control provided by tunable energy levels and density. Regardless of which form of ablative resurfacing is chosen the postoperative wound care is imperative to an uncomplicated recovery and requires a great deal of commitment on the part of the patient and caregiver. For the issues of volume they evolve around  repositioning and replacing. Repositioning is achieved through returning the facial fat pockets to their original position or repurposing adjacent volume examples would be the vertical vector deep plane facelift, orbital fat repositioning and the SOOF lift. These are the most reliable way to address volume and return it to a youthful appearance. Adding volume with alloplastic material or autologous fat plays a significant role in rejuvenation also. Changing facial structure with mentoplasty, malar and submalar augmentation or temporal augmentation with alloplastic  materials can be helpful but may alter the chapter of the face  which is not always desired by the aging face patient, most have been comfortable with the way the look for most of their life and just want to be refreshed. Autologous fat transfer can also be integrated when addressing the aging face. It can add volume where repositioning does not help such as the temples and can soften the facial contour by returning  balance in the malar and submalar areas while thickening the subcutaneous layer. All of these maneuvers may be helped and extended by neuromodulators and fillers. The goal of this lecture is to bring over 30 years of experience to this decision making process and hopefully help your patients.