Tissues sag downwards due to gravity:
This effect is more prominent in thick skin types. Eyebrows, upper eyelids, cheeks and neck are especially prone to be effected by gravity. As our age advances, our eyebrows and upper eyelids fold downwards, cheeks sag and lines descending from nose to lips deepen. Folding occurs at the margins of jaw bone, skin of neck loosens and jowl becomes prominent.
Soft tissue loss occurs in face:
Skin thins secondary to loss of subcutaneous tissue, cheeks loss their fullness, eye sockets deepen, bags under eyes become more prominent and middle facial region appears compressed. While middle facial region loses its fullness, facial skin folds to the margins of jaw. The face which appears ovoid during youth becomes more round and then takes a rectangular form.
Skin aging starts:
Skin thins and loses its elasticity. Spots and skins lesions which may lead to cancer occur, especially due to sun exposure. Mimic wrinkles form due to effect of mimic muscles. These generally occur as crowfeet at the margins of eyes, vertical lines due to frowning and linear lines due to lifting eyebrows between eyebrows. More wrinkles occur in thin skin types.
Most important factor that determines aging is genetics. An individual with good genetic structure ages well even in poor environmental circumstances. Otherwise, racial features are also important. While sagging due to gravity is more common in thick skinned Mediterranean race, wrinkles appear more prominent in thin skinned blond North European people.
The factors that we can control in regards to aging area as follows: Sleeping regularly, having a good diet, avoiding sun exposure, drinking high amount of fluids, not smoking, limiting alcohol consumption, avoiding stress and sadness, living in a clean environment, avoiding excessive make-up, using humidifiers and skin care products regularly.
We separate facial rejuvenation surgeries in three groups:
Upper face rejuvenation:
Forehead region, temporal regions, eyebrows and upper eyelids. Lifting procedures targeting sagging due to gravity are more commonly used for this area. These include forehead lift procedures, temporal lift, eyebrow lift, eyebrow suspenders, upper eyelid surgery (upper blepharoplasty) and botox applications.
Mid-face rejuvenation:
Lower eyelids, cheeks and cheek bones. The purpose of the procedures performed for this area is to correct lower eyelid-cheek connections, lifting the sagged cheek and replace soft tissue loss. These procedures include lower eyelid surgery (lower blepharoplasty), mid-face lift, mid-face suspenders, fat injections and restorations.
Lower face and neck rejuvenation:
Margins of jaw, lower lips and neck. The purposes of the procedures performed for this area are to lift the sagged face, correct skin folds that occur over jaw bone, remove excessive fat in neck and lifting the neck. These procedures include face and neck lifts and liposuction procedure to neck.
Non-surgical rejuvenation procedures include suspensions, skin peeling procedures, botox and restorative procedures.
Eyebrows, mid-face region and neck can be suspended with closed method and special sutures. They are effective against small sagging and their effects are temporary. However this is an appropriate method for patients who think it is early for surgery and patients who refuse surgery. They are performed under local anesthesia and postoperative recovery period is rather short.
The purpose of skin peeling applications are to remove spotted, damaged and wrinkled upper layer of skin to replace it with a new fresh skin tissue. This procedure is performed by either grinding the skin mechanically (dermabrasion) or peeling the skin with burning it with various chemicals (chemical peeling) or peeling the skin with assistance of laser beams. Lasers and other light applications also stimulate subcutaneous collagen production along with peeling the skin and ensure that the skin is thickened and refreshed.
The purposes of botox applications are to disable mimic muscles and prevent formation and deepening of mimic lines. Botox is generally applied at the periphery of eye. It is very effective for crowfeet at the margins of eyes, vertical lines between eyebrows and linear lines on forehead.
Various restorative materials are used in filling deep wrinkles in skin, replacing volume loss in mid-face region, high-lighting contours, filling out lips. While fat tissue obtained from the patient is preferred for wider areas, synthetic restorative materials are applied for smaller areas. Most frequently used one among them is a material called Hyaluronic acid which can be found in the connective tissue between body cells.
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