Facial Lines and Wrinkles
As our skin ages, it becomes more frail and is easily damaged.
The cellular intelligence also dulls and there is a decreasing ability of the skin to heal itself.
1) Skin has decreased volume and elasticity
2) Skin receives less blood flow and has lower glandular activity resulting in poor texture and dryness
The Glogau Classification system describes the severity of the wrinkles into five grades (mild, moderate, advanced and severe)
Mild – Few wrinkles, requires little or no make-up for coverage
Moderate – Early wrinkling, sallow complexion, requires little makeup
Advanced – Persistent wrinkling, skin discoloration with broken blood vessels and solar keratoses, often wears make-up
Severe – Severe wrinkling and furrows, solar keratoses, often wears make-up but it may not hide the ageing changes
The Fitzpatrick classification of facial lines refers to the degree of wrinkling around the mouth and eyes:
Class I: Fine wrinkles
Class II: Fine-to-moderately deep wrinkles and moderate number of lines
Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds
How do facial lines (rhytides) develop?
Many factors contribute to aging skin and the development of wrinkles and facial lines.
The cellular intelligence also dulls and there is a decreasing ability of the skin to heal itself.
1) Skin has decreased volume and elasticity
2) Skin receives less blood flow and has lower glandular activity resulting in poor texture and dryness
The Glogau Classification system describes the severity of the wrinkles into five grades (mild, moderate, advanced and severe)
Mild – Few wrinkles, requires little or no make-up for coverage
Moderate – Early wrinkling, sallow complexion, requires little makeup
Advanced – Persistent wrinkling, skin discoloration with broken blood vessels and solar keratoses, often wears make-up
Severe – Severe wrinkling and furrows, solar keratoses, often wears make-up but it may not hide the ageing changes
The Fitzpatrick classification of facial lines refers to the degree of wrinkling around the mouth and eyes:
Class I: Fine wrinkles
Class II: Fine-to-moderately deep wrinkles and moderate number of lines
Class III: Fine-to-deep wrinkles, numerous lines, and possibly redundant folds
How do facial lines (rhytides) develop?
Many factors contribute to aging skin and the development of wrinkles and facial lines.
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Most faces demonstrate a degree of asymmetry since facial wrinkles tend to develop more on one side than the other, based on certain habits, such as sleeping positions or sun exposure while driving.
Fine Lines
Fine lines arise because of a decrease in the amount of water held by the epidermis and an irregular thickening of the dermis. Sun damage and environmental toxins (eg. tobacco smoke) are the more serious offenders.
Furrows
All facial lines pass through 2 stages : dynamic or static
Dynamic wrinkles appear with movement and the activity of the facial muscles. Static wrinkles persist regardless of facial expression and muscle movement. Eventually with age all dynamic wrinkles become static (permanent).
Fine Lines
Fine lines arise because of a decrease in the amount of water held by the epidermis and an irregular thickening of the dermis. Sun damage and environmental toxins (eg. tobacco smoke) are the more serious offenders.
Furrows
All facial lines pass through 2 stages : dynamic or static
Dynamic wrinkles appear with movement and the activity of the facial muscles. Static wrinkles persist regardless of facial expression and muscle movement. Eventually with age all dynamic wrinkles become static (permanent).
- Crow's feet around the eyes are due to smiling and activity of the eyelid muscles (orbicularis oculi).
- Worry lines on the forehead are due to contraction of the frontalis muscle when raising the eyebrows
- Frown lines between the eyebrows are due to contraction of corrugator supercilii muscles and procerus muscle when concentrating or angry
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Freefall with Gravity
Skin laxity or looseness is brought about by certain factors that leave undesirable results.
a) decline in the number of fats cells under the skin (subcutaneous tissue)
b) shrinkage and loss of collagen and elastin fibers in the dermis (resulting in decreased strength and elasticity)
c) Gravity - allows the skin to sag and sink without resistance
The Undesirable Results include :
Treatment
1) Sun avoidance/ sun protection is paramount
2) Avoid smoking/ second hand smoke
3) Moisturize (frequently) - to improve skin hydration and appearance of fine lines
4) Suncreen, broadbrim sunhats, long sleeves and limit time outdoors during peak UV intensity (10 am - 4pm)
Resurfacing
Skin resurfacing and rejuvenation - can be achieved by several methods, ranging from lasers, lights, to chemical modulators.
The outcome is smoother, clearer, blemish-free, younger looking skin)Remarkable changes in facial appearance can be obtained, giving a younger appearance and improving complexion. Often combinations of different cosmetic procedures are required for the best results.
Skin laxity or looseness is brought about by certain factors that leave undesirable results.
a) decline in the number of fats cells under the skin (subcutaneous tissue)
b) shrinkage and loss of collagen and elastin fibers in the dermis (resulting in decreased strength and elasticity)
c) Gravity - allows the skin to sag and sink without resistance
The Undesirable Results include :
- Brow ptosis (the forehead sags so the eyebrows drop over the eyelids, which then feel heavy)
- Eyelid ptosis (the upper eyelid drops, sometimes obscuring the pupil)
- Baggy upper and lower eyelids
- Sagging lower eyelids, revealing the reddened mucosal surface (ectropion)
- Hollow look to the eyes
- Tired-looking eyes with a prominent groove beside the nose (tear-trough deformity)
- Jowls (loss of jaw line)
- Loss of neckline
- Elongated earlobes
- Dropping of the tip of the nose
- Thinning of the upper lip
Treatment
1) Sun avoidance/ sun protection is paramount
2) Avoid smoking/ second hand smoke
3) Moisturize (frequently) - to improve skin hydration and appearance of fine lines
4) Suncreen, broadbrim sunhats, long sleeves and limit time outdoors during peak UV intensity (10 am - 4pm)
Resurfacing
Skin resurfacing and rejuvenation - can be achieved by several methods, ranging from lasers, lights, to chemical modulators.
The outcome is smoother, clearer, blemish-free, younger looking skin)Remarkable changes in facial appearance can be obtained, giving a younger appearance and improving complexion. Often combinations of different cosmetic procedures are required for the best results.
- Superficial and medium-depth chemical peels
- Dermabrasion and microdermabrasion
- Neodynium:YAG or carbon dioxide laser resurfacing
- Non-ablative laser, intense pulsed light or thermal resurfacing including thermage
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Botulinum toxin (Botox)/ dysport/
The recent headliner laser has been “Ulthera”, a high intensity focus ultrasound which is FDA approved for lifting skin on the eyebrows, neck and under-chin area. This tissue tightening device is painful and costly but photographs of impressive results may be quite alluring to patients. New indications exist for non-animal stabilized hyaluronic acids, including nasal shaping, elbow/knee creases, and cellulite. For patients that fear bruising following these fillers, consider treatment with the V-bean laser, or avoid the potential for bruising altogether with microcannulas. Rather than using traditional needles, microcannulas are blunt tipped and require only a single portal of entry leading to less bruising, discomfort and edema. |
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Botulinum toxin is a protein and neurotoxin produced by the bacterium Clostridium botulinum. It is the most acutely toxic substance known, with an estimated human median lethal dose of 1.3–2.1 ng/kg intravenously or intramuscularly and 10–13 ng/kg when inhaled. Botulinum toxin can cause botulism, a serious and life-threatening illness in humans and animals. Popularly known by one of its trade names, Botox, it is used for various cosmetic and medical procedures.
Cosmetic surgery
Cosmetic facial surgery involves re-positioning facial tissues (rhytidectomy) and altering the structure of the sagging tissues.
Cosmetic surgery
Cosmetic facial surgery involves re-positioning facial tissues (rhytidectomy) and altering the structure of the sagging tissues.
- A facelift or mid-face lift remove excessive skin and tighten underlying muscles of the lower two thirds of the face (cheek and neck).
- A forehead or brow lift, and mid-temporal lift reduce static lines and lift up drooping eyebrows.
- Rhinoplasty may lift up the tip of the nose, reshape it or thin out excessive tissue due to rhinophyma
- Upper and/or lower blepharoplasty removes redundant skin and fat pads from the eyelids.
- Correction of platysmal bands in the neck by an open plication technique improve the appearance of a sagging neck.