Restore volume, then "lift"

The most obvious sign of aging in the face is the loss of volume. Until recently, we would try to restore a youthful appearance by lifting the tissues that have the appearance of having fallen. We now know that a lot of that "fallen" appearance is actual deflation. Sure, there are factors such as the loss of elasticity and descent of tissues from gravity, however if only one of the factors is dealt with,  then you will never look like they did in the past. I use old photographs of the individual that I am considering for rejuvenation to determine what has changed so I can make the correct surgical and nonsurgical approach.  I used to like to start with photographs from high school her college graduation or perhaps a wedding photo and then see how the face progresses into the 30s and 40s. The majority of my patients come in to my office for facial aging in the 50s or 60s. I have seen quite a few patients take a proactive approach and get an opinion on what to do in their late 30s and early 40s. Sometimes in the individual's did not like there facial shape when they were young and liked the more sculpted look they developed in their early adulthood years. With the help of Vectra 3D-( three dimensional photographic) system we can analyze exactly what has taken place as the face changes over the years and make the appropriate changes.

Using this technology I can map out the plan for restoring the desired shape and appearance to the face. The first building block is to restore volume in the critical areas such as the cheeks, the jaw line, and the brow and temporal area. Other areas of concern include the area around the eye especially the hollow of  the upper eyelid and the junction between the eyelid bag and the cheek (tear trough).

Too many times patients feel their lips are too long. This sometimes is true but most often the problem is that the lip  loses volume and needs to get resculpted. In the lip it is particularly important to look at what the original lip volume was as well as the shape.  If one tries to change naturally small lips into full lips the results can be rather obnoxious. The lip in particular loses volumes in two areas: the first being the actual lip volume and where the pink vermilion is visible in the front view and secondly in the lip line where the normal skin and the pink vermilion interphase. It is that second area of the lip line which is critical to treat with volume before addressing the overall shape of the lip. This lip line filling has a benefit of erasing fine lines that are often blamed on "smoking" or drinking through a straw. The volume loss in this area combined with loss of elasticity results in the spine lines which are often more visible when you put on lipstick and the lipstick goes up into these crevices. The 10X mirrors that are often used to apply makeup often exaggerate these lines and add to the magnitude of the concerns.

 The cheeks and the areas just below it are often areas that are misunderstood by plastic surgeons and dermatologists.  The problem is that they  have a tendency to put too much volume into the cheeks in an unflattering exaggerated way. This is often made worse by the over stuffing of the lips creating a caricature of youth rather than restoring the youthful "natural appearance". Another area that loses volume and can easily be treated is the jaw line. Volume placed in front of the "jowl" and near the angle of the mandible can re-create the beautiful jawline and strengthen the chin that will set off the contrast between the face and the neck.

Restoring volume to the orbital tissues ( eyelids) requires more study and more artistry. The tissues here are thin and a little bit goes a long way.  The temporal hollows can be restored to their natural youthful appearance with a little volume especially in the deep layers. The brow pad restoration can actually give the appearance of lifting the eyebrow.

My favorite volume restoration has been fat grafting for many years. Hyalouronic acid fillers such as Juvederm and Voluma however are getting better and lasting longer. They are easily obtained, injected, and adjusted and even erased if needed.

Sculptra is a collagen volume stimulator they can also be used in certain areas of the face to restore volume.  Under no circumstances should you let anyone inject silicone into your face or any other part of your body as the body's reaction can be quite unpredictable.

Only after you have restored the face to the proper volume can you consider lifting the tissues that have relaxed and now cause the rest of the evidence of facial aging. Facelifting in a natural way...ahhh, that we leave for another day.

Other Articles Of Interest:

Voluma Powerpoint
Volume Restoration Is Basis Of Facial Rejuvenation
Seri Scaffold For Long Term Breast Lifting Results
Lightweight Breast Implants
Internal Bra developed for Long Term Breast Lifts

Other Videos Of Interest:

Fat Graft Facelift Naples
Fat Graft Harvesting
Actual Facial Volume Restoration in Naples

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