Clinical Approach to the Aging Face

FACESFolds Research has shown that loss of facial tissue is a major cause of ageing. The youthful convex cheek is gradually flattened and eventually becomes concave. Most fillers help correct this, especially cheek volume fillers and folds such as nasolabial

• “Man made “fillers and new Fat transfer methods /Fat banking

Angle• Assess the angle of the mouth and the lower face for facial tissue drooping. Face lifting of Skin Suture lift

will be appropriate.

Complexion• With ageing and sun damage the skin looses its fresh look and may become pigmented, thinned and

develop wrinkles. • There is a wide range of approaches for skin texture and skin smoothing, botulinum is also appropriate in

this context.

Eyes• The area around the eyes can create and aged appearance in three ways. Treatments can focus on these

changes.

Side View• A very common cause of aging is the collection of fat and loose skin around the neck that causes a loss of

the angle of the jaw, particularly side on. A relatively simple procedure is described which causes removal of fat and skin retraction.

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f

a

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FF Folds

• The youthful convex cheek is lost• Shadow• Concave• Wrinkle

• Two options • Hyaluronic acid - Voluma / Q med – cannulated• Autlogous fat

Movie star with depressed cheeks

FF FoldsFat Transfer

•A- Advive• Enclosed system• Centrifuge with filter

•B – Bank• Extraction fact• Pure graft• Cryopreservative – DSMO, Humans Serum Albumin, Dextran 40• Bar code• Slow rate freeze• Deep freeze -190OC

•C – Cellbrush• Microdroplets• Controlled• 19 gauge needle

Fat Transfer

•A- Advive

•B – Bank

•C – Cellbrush

FF Folds and Filler

A-A- Advive

-Enclosed system-Centrifuge with filter

B B – Bank

• Extraction fact• Pure graft• Cryopreservative – DSMO, Humans

Serum Albumin, Dextran 40• Bar code• Slow rate freeze• Deep freeze -190OC

Why Fat Bank?

• Fat often needs to be repeated

• No further liposuction

• Own filler

• ? Role stem cells

• ? other uses

CC – Cellbrush•Microdroplets

•Controlled

•19 gauge needle

Folds

Folds and Fillers

Folds and Fillers

Folds and Fillers

Folds and Fillers

A Angle Mouth / Angle Jaw

Face Lift Assessment•Jowls, nasolabial fold, low face, squaring jaw line•Options – face lift and suture lift•SutureMirror test, non permanent. preauricular fold, neck lipoAdvantage – predicable, simple, less invasive, immediate / no down timeDisadvantage – temporary, preauricular fold, pain ear

Suture Lift

Angle Mouth / Angle Jaw

Suture lift/ facial fillers

Angle Mouth / Angle Jaw

CC Complexion

Skin Texture Assessment •Patients skin texture(olive, fair)•Dyschromia ? Pigmentation / Blood vessels / keratosis•Fine lines•Deep lines(Upper lip)•Active or static (eg eyes or pursing or smile lines)•Folds or wrinkles•Pores

Star with women skin bad

Complexion

laser resurfacing• Deep full face or localised erbium• Demarcation• Sun, fair fine or deep lines ideal

Photorejuvination • Fraxionated, Yag- Revlite, IPL• Airgent

• Lesion directed eg laser for moles, lentigenes, veins

Complexion

Complexion

Complexion

Complexion

Complexion

EE Eyes - UpperAssessment •Look straight ahead without frowning.(is the problem with brow or the skin on upper lid.)•Eye structure / brow structure(what effect will bleph have)•Assess upper medical fat•If both brow and lid assess effect one procedure(remove skin lateral – scar)

Eyes – Upper

Treatment• CO2 Laser Blepharoplasty• Brow lift• ? Suture lift• Brow non surgical – Botox

- Fillers

- Ulthera skin/muscle

Eyes - Upper

Eyes - Upper

Eyes - Upper

Eyes - Upper

Eyes - Upper

EE Eyes - Lower

Assessment •Look straight ahead and then look up(brings fat bulge forward)•Assess position fat(medical, central, lateral)•Assess skin texture lines at rest and/or squint•Assess amount loose skin(subconjunctival or excision)•Assess tear trough(? depression)•Assess surrounding anatomy(?cheeks filler, ?skin full face)

Eyes – Lower

Treatment• Subconjunctival CO2 Blepharoplasty – 3

areas fat• Erbium skin therapy• External Blepharoplasty – tighter skin

- risk: scar, ectropion, lid lag

Eyes - Lower

Eyes - Lower

Eyes - Lower

Eyes - Lower

Summary

SS Side View

Jaw Line•Liposuction• “what happens to skin”•Skin texture(wrinkling less visible)•? Permanent / knumb / hard•Combination option

Side View

Side View

Side View

Side View

Make Over

Make over

Make over

Make over

Make over

Make over