Contemporary Facial Rejuvenation Based on the Anatomy of Aging

A smaller lower face has been shown to be more attractive and youthful looking. Recent research (at the University of Texas - Southwestern and published in the journal, Plastic and Reconstructive Surgery in 2008 by Dr. Joel Pessa) has shown that, as we age, the lower jaw continues to grow more so than the rest of the face. Therefore, there is a change in the shape of the face as we get older that in some patients makes it less attractive. These bony changes combined with the loss of facial fat in the cheeks and eyes accentuates the appearance of age. A youthful face is full which is lost as we age, particularly around the eyes and cheeks. These bone and fat changes make the cheeks more sallow and give the impression, with the development of jowling, that the chin is bigger.

Understanding these aging changes provides new directions as to how to approach facial rejuvenation surgery in the aging patient. While you can't make the jaw smaller, you can make it appear smaller by augmentation of the cheek and midface areas. This can be done with either fat grafts or cheek implants. Which one is best must be individualized for each patient. Cheek implants or submalar (under the cheek) implants can help lift a sagging midface as well as provide better cheek projection. If malar crescents (sagging skin from the lower eyelid hanging on the cheek) are significant, then a midface lift may also be done with a lower blepharoplasty (eyelid tuck) to work out the excess skin as well. Fat grafting by injections has proven to be a very valuable addition to the cheek area as well and it can be tailored to add fat to a variety of facial fat compartments including the cheek and lateral facial areas.

The lower face and unsightly jowling still relies on the 'traditional' facelift approach with the objective of eliminating the jowling and tightening up loose neck skin. This effect, combined with cheek volume restoration, helps make the face look younger by changing the disproportions caused by aging.

In the younger patient with early signs of facial aging, injectable facial fillers can be an effective non-surgical approach in the cheek area. When these fillers become more long lasting or even permanent, we will see more of these patients seeking these treatments earlier before the negative facial effects of aging become too noticeable.

Contemporary plastic surgery evaluates and treats the midface-cheek area as well as the neck and jowl to restore overall facial fullness and proportion. This approach results in a more youthful and balanced facial appearance.