Facial Aging and Atrophy
“Overview”

Causes of Facial Skin Aging

Research shows that there are, in fact, two distinct types of aging. Aging caused by the genes we inherit is called intrinsic (internal) aging. The other type of aging is known as extrinsic (external) aging and is caused by environmental factors, such as exposure to the sun’s rays.

Intrinsic Skin Aging:

Intrinsic aging, also known as the natural aging process, is a continuous process that normally begins in our mid-20s. Within the skin, the dermis of normal (wrinkle-free) skin is composed of abundant amounts of type I collagen and type VII collagen, as well as elastin, which provide tissue strength, resiliency and recoil. The skin cells in the dermis also produce hyaluronic acid, a sugar complex that traps and holds water in the skin and which gives the skin “cushioning” and provides a supple and soft appearance. As dermal fibroblasts begin to age, they produce decreasing amounts of collagen and elastin. Further, aging fibroblasts produce increased amounts of enzymes called matrix metaloprotienases (MMP’s), which degrade collagen and elastin. This “aging” process results in a drastic loss of collagen and elastin over time and results in skin laxity and fragility, visible in the form of fine lines and wrinkles.

The signs of intrinsic aging are:

  • Fine wrinkles
  • Thin and transparent skin
  • Loss of underlying fat, leading to hollowed cheeks and eye sockets as well as noticeable loss of firmness on the hands and neck
  • Dry skin that may itch

Genes control how quickly the normal aging process unfolds. For example, in regard to greying hair, some notice those first grey hairs in their 20s; others do not see greying until their 40s.

 

Extrinsic Skin Aging:

In extrinsic aging, a number of external factors often act together with the normal aging process to prematurely age our skin. Most premature aging is caused by sun exposure. Other external factors that prematurely age our skin are repetitive facial expressions, gravity and smoking.

Sun Skin Damage:

Without protection from the sun’s rays, just a few minutes of exposure each day over the years can cause noticeable changes to the skin. Freckles, age spots, spider veins on the face, rough and leathery skin, fine wrinkles that disappear when stretched, loose skin, a blotchy complexion and skin cancer can all be traced to sun exposure.

“Photoaging” is the type of aging caused by exposure to the sun’s rays. The amount of photoaging that develops depends on:

  • a person’s skin colour.
  • their history of long-term or intense sun exposure.

People with fair skin who have a history of sun exposure develop more signs of photoaging than those with dark skin. In the darkest skin, the signs of photoaging are usually limited to fine wrinkles and a mottled complexion.

Photoaging occurs over a period of years. With repeated exposure to the sun, the skin loses the ability to repair itself, and the damage accumulates. Scientific studies have shown that repeated ultraviolet (UV) exposure impairs the synthesis of new collagen and increases the expression of MMP enzymes, which break down collagen. The sun also causes changes and breaks in elastin, leading to a condition referred to by dermatologists as elastosis. Due to the loss of collagen and changes to the organization of elastin, sun-weakened skin ceases to spring back compared to skin protected from UV rays. The skin becomes loose, wrinkled, and leathery much earlier in life when the skin has been exposed to the UV rays of sunlight without adequate sun protection.

Facial Aging & Rejuvenation

Not all faces age in the same way, nor do they require the same procedures for rejuvenation. The degree of volume loss, tissue descent, and skin changes will vary. Each face ages individually, with some areas remaining more youthful than others. For this reason, we do need to evaluate the entire face & neck, assessing skin quality, volume changes and descent.  Restoring a youthful & attractive reflection to the face requires attention to both rejuvenating and reshaping major facial structures and restoring any minor youth cues that has been missed. The patients who have lost the major youth signs, they do need major surgical approaches to correct it like;

  • Firming the neck,
  • Eradicating jowls
  • Softening the nasolabial folds
  • Recreating a strong jaw line which will portray a more youthful appearance.

 The major facial surgeries like face & neck lift, though successful in a basic sense, remained incomplete because minor age cues were left unaddressed. Up until recently facial plastic surgeons used to focus on the major changes of aging such as prominent nasolabial folds, drooping brows, sagging jowls and hanging neck. Patients with significant facial atrophy will generally achieve suboptimal improvement from both surface treatment of facial skin & surgical lifts. The addition of fat to areas of the face that have atrophied from age or disease can produce a significant and sustained improvement in appearance that is unobtainable by other means.

Minor age cues are those developments that signify an aging face but are often unnoticed since they are subtle and subliminal in nature. Some of it can be seen on faces of massive weight loss patient although they are still young due to rapid significant weight loss of facial fat.  At the time need to address the minor youth cues such as:

  • Lower eyelid hollows (“tear troughs”)
  • Lower eyelid dark circles
  • Hollowing of the temples
  • Area in front of the ear and below the cheekbones
  • Sagging of the corners of the lips.
  • Lip volume & definition
  • Mental crease
  • Chin definition

These minor age cues mainly result from loss of subcutaneous fat, imparting a “drawn-out” appearance. With new micro-techniques and a better appreciation and keener eye, these heretofore stubborn minor age cues can be successfully corrected with fat transfer. 

Fat contain Adipose Derived Stem Cells (ADSCs) that are believed to elaborate growth factors and have regenerating effect on adjacent tissues, and it is likely will rejuvenate & regenerate the facial structures.

Facial Atrophy & asymmetry not related to Aging Process

  1. Thin or skinny face or long face.
  2. Facial volume atrophy after weight loss specially after massive weight loss
  3. Facial deformity & asymmetry after trauma defect or post-surgery defect like excision of facial tumour.
  4. Facial asymmetry due to congenital defect like hemifacial atrophy.

References:

  1. Alberto Di Giuseppe, Dennis Wolf. Breast Augmentation with Stem Cells Fat Trasnfer and VaserTM. In: Melvin A.Shiffman, Alberto Di Giuseppe, Franco Bassetto, editors, Stem Cells in Aesthetic Procedure: Art, Science, and Clinical Techniques. Springer-Verlag Berlin Heidelberg; 2014. P 529-56. 
  2. American Society of Plastic Surgeons. Report of the 2010 statistics: National Clearinghouse of Plastic Surgery Statistics. 2010, http://www.plasticsurgery.org/news-and-resources/statistics.html. Accessed June 5, 2017. Click Here for PDF
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  8. Sasaki, G. H. (2015). “The Safety and Efficacy of Cell-Assisted Fat Grafting to Traditional Fat Grafting in the Anterior Mid-Face: An Indirect Assessment by 3D Imaging.” Aesthetic Plast Surg 39(6): 833-846. Click Here for PDF
  9. Zhu M, Zhou Z, Chen Y, Schreiber R, Ransom JT, Fraser JK, Hedrick Mh, Pinkernell K, Kuo HC. Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Ann Plast Surg. 2010;64(“):267-71 Click Here for PDF
  10. Zins JE, Moreira-Gonzalez A. Cosmetic procedures for the agingface. Clin Geriatr Med. 2006;22:709–728. Click Here for PDF
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