The secret to ageing gracefully

As you may be aware, it is my passion to deliver natural looking, attractive and durable results with my facial rejuvenation treatments. The basis on which I can deliver such results depend on several factors: a thorough understanding of the underlying anatomy and how these structures are affected by the natural ageing process, an artistic eye, a good knowledge of the physical properties of injectable products, and a full arsenal of advanced techniques at my disposal.

Whilst most people think of wrinkles as the primary manifestation of facial ageing, the reality is a lot more complex. The ageing process affects the entire facial structure, including skin, subcutaneous fat, muscles and facial bones. It is my firm belief that a natural looking result can only be achieved by mimicking a more youthful facial structure, and as such a detailed analysis of the anatomical changes that take place in our face as we age is absolutely critical. I would like to share with you some of my latest insights in this regard.

In the latter half of the twentieth century, soft tissue sagging was thought to be responsible for most of the visible ageing changes in the face. Within the past decade or so, volumetric changes are now recognised to play a more major role. Much attention has been focused on the changes of the subcutaneous fat compartments but within the past few years, there have been some rapid advances in the understanding of age-related changes of the facial skeleton. For a long time, the prevailing wisdom was that the facial skeleton continued to increase in size with age, this was based on the observation that certain ratios, such as the nasal height, increased with age. The fact that the facial skeleton undergoes extensive remodelling and resorption (shrinkage) has not been well appreciated or recognised until recently. This has been where I have focused my recent research.

In parallel with the soft tissue changes, the facial skeleton undergoes remodelling with age, albeit at a slower pace. As bones remodel, they change shape and they decrease in size. The process of remodelling does not occur uniformly and it affects certain facial bones more than others.

The mid face undergoes the most comprehensive remodelling and these changes are readily observable by the mid thirties. The mid face consists of two bones: the maxilla and the zygoma. The maxilla remodels more rapidly than the zygoma. The maxilla decreases in height, retrudes (sinks backwards) and the maxillary angle (tilt) increases.

The skeletal support of the lower third of the face comes predominantly from the mandible (jaw bone). Like the mid face skeleton, the mandible also undergoes extensive remodelling. The height of the mandible decreases. The bend in the mandible becomes straighter. These changes have significant implications in the signs of lower facial ageing, particularly jowl formation.

The upper face is not spared. Frontal bone changes result in an increase slope of the forehead and the development of lower forehead hollows. The brow ridge becomes less prominent.

The eye sockets and the nasal cavity, being the ‘negative space’ in artistic parlance, enlarge.

As the muscles and ligamentous supports of the face have their deep attachments on facial bones, the remodelling of these bones has more far reaching consequences than just volumetric changes alone. Resorption of the lateral orbital rim (the outside of the eye socket) causes the lateral canthal tendon to descend, which in turn manifests as the outside corner of the eye sagging. The enlargement of the nasal aperture causes the cartilaginous part of the lower nose to sink inwards, causing the nasal tip to droop with age. This gives the apparent impression of elongation of the nose, hence the myth that the nose grows bigger with age.

As you can see, there are many changes taking place in your face as you age. These changes start from your early twenties and dramatically get worse when you hit forties and fifties. I had a number of opportunities over the past few years to witness some of the worlds best injectors in action, and they were very generous in the way they shared with me how they approach their treatments. I believe the old technique of just injecting dermal fillers into your cheek area or treating your face with anti wrinkle injections will become a thing of the past.

My focus, along with these top injectors, is to have an excellent understanding of the facial anatomy, especially the structural changes that are taking place. By injecting small amounts of dermal fillers in selected areas of the face, you can really notice an incredible immediate difference to ones appearance. Artistic judgement and experience is paramount when performing these treatments. I am still amazed at how much of an overall facelift can be achieved from just dermal fillers alone.

The benefits are less bruising, minimal or no downtime and natural looking results. By understanding the structural and ageing changes that have taken place, these can be corrected with dermal fillers. It is never about making someone look like a different person, but making them look like a better version of themselves.

If you would like to look rejuvenated, less tired and improve your overall facial appearance, then dermal fillers could be your solution.

Site Images / 20120628 Bernard Leung SNB_0338 (medium)I am constantly researching and finding out what is the most up to date treatment techniques and information for my patients. Through my years of experience, I have come to the conclusion that in addition to performing treatments with technical excellence it is important to:

  • perform a thorough assessment based on a detailed understanding of facial anatomy and the pathophysiology of ageing
  • have an exceptional artistic eye to achieve an aesthetic outcome
  • have sound application of the principles of 5Rs
  • formulate a treatment plan based on these principles
  • apply expert technical skills to carry out procedures and treatments