Flashcards in Evaluation and management of the ageing face Deck (53):
Young faces are characterized by the absence of wrinkles.
T But also arcs and fullness.
Evaluation of the ageing face must take into account changes that occur in all levels of tissue.
T Need to approach the ageing changes in each layer separately.
Changes in muscle mass and tone are the most substantial contributors to soft tissue changes in ageing.
F Fat is the most substantial contributor.
Ultrastructural changes in collagen and elastin lead to coarse rhytides or folds.
F These are more likely due to soft tissue atrophy or muscular movement.
Sarcopenia refers to skeletal muscle wastage with age.
Facial mimetic muscles atrophy with age.
Repeated facial animation over time, in conjunction with chronic UV exposure, permanently fibrose the skin to the muscle and set in the dermal component of rhytides.
Lack of subcutaneous fat in the ageing face allows the mimetic muscles to pull the skin along.
The contour of the mandible changes with age.
There is an increase in vertical maxillary dimension with retrusion of the lower maxillary skeleton with ageing.
An overall slight narrowing of the face occurs with ageing.
There is an overall increase in the facial height with ageing.
Skeletal remodelling in adulthood changes the facial dimensions to that of an infant, with an increase in the ratio of the maxillary height to the orbital height.
Craniofacial skeletal aging changes are even more dramatic in edentulous people.
Ageing causes the orbital rim and anterior cheek to move posterior relative to the cornea, causing the eye to appear proptotic.
Gravity is responsible for the hallmark shape of the ageing face.
F Fat redistribution more likely.
The face of the middle to late 20s is the standard in desirability of aesthetics.
The overall shape of the young face is triangular, with the apex of the triangle occur at the forehead and the base at the zygoma.
F Apex at the mentum, base at the temples.
The contours of the young face occur because of ampleness in the deep fat compartments.
The face ages as a confluent mass.
F Individual fat compartments.
In the ageing face, there is unbalancing of the face with areas corresponding to fat hypertrophy and/or fat atrophy.
T Causes hill and valley topography and abundance of shadows.
The overall shape of the ageing face is triangular, with the apex of the triangle occurring at the mentum and the base at the temples.
F Apex at the level of the glabella, base at the jawline.
In the ageing face , the temples become concave.
In the ageing face, the lateral third of the face becomes concave.
In the ageing face, the lower third of the face is arced on with a sweep of the jawline from ear to ear.
F This is true for the young face. Ageing face replaces the arc with an undulating curve.
In the ageing face, the jaw has an anterior projection that then wraps inferiorly, forming an obtuse angle with the neck.
F This is true for the young face. Ageing face loses definition with respect to the neck.
In the ageing face, cosmetic units flow.
F demarcated at underlying bony landmarks.
A young nubile face is represented by fullness, arcs and many points of highlight.
A patient’s weight does not affect the ageing face.
Facial fat mirrors body fat.
Patterns of facial fat atrophy and fat hypertrophy are changes that are relative to each other.
In the young face, the facial fat is ‘balanced’ so that the face becomes rounded and homogeneously full.
In the ageing face, weight can only be gained in patterns that correspond to hypertrophic areas.
Only heavy ageing faces exhibit sagging as a direct result of fat redistribution.
F Also lean ageing faces.
In the ageing face of a lean person, fat collects in the lower third of the face leading to jowls and prominent submental fat.
F Ageing face of a heavy person.
Due to the loss of support from deep fat atrophy, a lean ageing face will collapse in the direction of gravity.
A heavy ageing face will hold its shape regardless of the direction of gravitational pull.
F A young face
Re-establishing the anterior projection of the cheek can serve to ‘lift’ the face forward and correct sagging
There is an ‘optimal’ elasticity of skin, a point at which it is neither stretched nor deflated.
T This is seen in youth when the face is appropriately full of fat at ideal body weight.
‘Elastic recoil’ is the point where the skin has the ability to ‘snap’ back to its original position when stretched.
If an older person loses the subcutaneous fat layer, the overlying skin responds to the changes underneath by exhibiting ‘supercontraction’.
F This occurs in younger people.
Photoageing is not responsible for the inelasticity of ageing skin.
IPL, lasers, LN2, peels and retinoids can all be used for the poikilodermatous changes in the ageing face.
Textural changes and fine wrinkles cannot be treated with IPL.
Wrinkles at rest are best treated with botox.
F Wrinkles in motion.
Wrinkles in motion are best treated with fractionated lasers and superficial fillers.
F Wrinkles at rest.
Cosmetic improvement of the changes that occur with ageing must be specific to the structure or level of the skin in which the ageing occurred.
Solar elastosis causing wrinkles with deep skin involutions is best treated with resurfacing methods.
F Resurfacing is best for superficial creases in the skin.
Involutional changes of skin ageing (eg folds in the nasolabial area) are best treated with fillers. .
F Traditional rhytidectomy or structural augmentation
Facial sagging is an atrophic event, occurring in the direction of gravity.
In the treatment of the ageing face, care must be taken to reapproximate the shape and arcs of the young face.
Structural facial rejuvenation is that which replaces the bone and soft tissue.