Strategies to maintain a youthful face throughout your life
Age is certainly just a number. What is more important is your physiologic age which is a culmination of genetics, diet, exercise, sun exposure protection, smoking status, and how well a person manages any chronic diseases. But in general terms I find it useful to stratify algorithms for best practices for maintaining a youthful face into decades of life.
In the late teens and twenties the single best strategy for long term health and appearance of the skin of the face is appropriate sun block protection. Excessive unprotected sun exposure and tanning beds may yield what appears at a brief moment in time as a healthy glow to the skin will ultimately result in loose inelastic skin with greater degrees of wrinkling along with unfavorable splotchy pigmented appearances. The sun makes everyone happy and feel good but our skin must be protected with hourly reapplication of sun screen while in direct sunlight and every morning a layer of sunscreen applied as part of a normal routine for face care. Peels, Laser’s, micro-needling, and home skin care can improve and repair some of the damages but prevention is the best course to look your best over time. Another aspect of care during the twenties is preventative treatment of severe acne formation of the skin. Anyone who has been left with multiple ice pick scars from cystic acne would do anything to improve the surface of the skin. Once again Lasers and micro-needling can improve the appearance but cannot eliminate all the scaring. Routine facials, extractions of pores, topical application of metronidazole or doxycycline, toners, retinols and, fruit acid applications are all useful tools to combat skin pores from clogging, become infected, and resulting in severe inflammation with resultant scaring of the dermis.
While still being youthful the physiology of the skin can change somewhat particularly dependent on genetics, the degree of skin pigmentation protection, sun exposure, and hormonal changes related to pregnancies. If someone is an avid tanner the repercussions of a couple of decades of excess UVA and UVB radiation from sun can already be seen in the skin’s appearance. Also unfortunately women who have been pregnant may experience hyperpigmentation of the skin about the face. As skin elasticity is reduced the animation of muscles directly under the skin around the eyes, forehead, and mouth may begin to create wrinkles during this decade and rapidly progress throughout the rest of the life of the individual. An important tool to alter the progression is the use of neuromodulators such as Dysport and Botox. These chemicals, derived from the botulinum toxin, block nerve transmission to the muscle thus reducing their tone leading to ellimination of wrinkles of the skin overlying the muscle. This treatment can help not only the immediate appearance of the facial lines but can also act as a preventative measure to avoid deep folds in the face if administered routinely from the thirties on. Also depending on an individual’s anatomy or issues of chronic sinus disease of the ethmoid sinuses some people may begin to have the appearance of bulging lower eyelid fat pads with an increased eyelid cheek junction demarcation which may lead to a fatigued demeanor of the eyes. Many times this can be reduced in appearance with the injection of a hyaluronic acid filler agents ( Restylane and Juvaderm) blending the eyelid and cheek junction similar to photo-shopping the bags out of a portrait. Even in the thirties this can make a nice refreshing improvement in the eyes and face with no down time except some minor bruising that can be easily covered up with makeup.
This is the decade where programed fat atrophy begins to occur leading to aging facial appearances. The fat in our face is in discrete packets under our skin and when certain fat pads begin to shrink in volume particularly the cheek fat pad (sub-malar fat pad), and the temporal fossa fat pad (in the temples) the cheek projection begins to diminish leading to a landslide affect that pivots along the nasolabial fold enhancing this structure and flattening the upper cheek, and causing the corners of the mouth to descend. In the temple region with reduction of volume the lateral brow begins to fall into the upper eyelid space. Fortunately plastic surgeons can reverse these changes with adding volume back into these spaces with either hyaluronic acid filler agents or induction therapy with Sculptra which stimulates the body to produce collagen to replace the missing fat. These non-surgical techniques have made big strides in warding off the early signs of aging. Also during the forties neuromodulators such as Botox and Dysport can play even more important roles in balancing muscle activity to provide subtle lift to the brows, minimize crow’s feet around the eyes, and reduction of muscle tone of the upper lip to avoid animation vertical lines during smiling. Lips are certainly a focal point of the middle third of the face and can experience signs of aging with the loss of a three dimensional appearance of the upper lip, down-turning of the corners of the mouth, and reduced skin tone leading to vertical lines. Hyaluronic acid filler agents can be utilized to subtly define the vermillion-cutaneous border of the lips, recreate the vertical columns that extend from under the nose to the each high point of the cupids bow of the upper lip as well efface deeper vertical lines that extend vertically from the vermillion. Improvement in the tone of the upper lip skin can be developed with micro-needling (Please see previous blog for this technique). Unwanted pigmentation blotches can be reduced by home treatments with retinols, topical vitamin C, and niacinamide combined with serial skin peels to provide more even tones.
The Fifties and beyond
All treatments listed in the forties can certainly be continued into the later decades to promote longevity of youth. However gravity and tissue thinning and loss of elasticity is ongoing and never ceasing, leading many to pursue surgical options to correct hanging brows, loose upper and lower eyelid skin, and restore normal jaw line appearances. See blogs on surgical rejuvenation of the face.