Nothing is so discreet as a young face, for nothing is less mobile; it has the serenity, the surface smoothness, and the freshness of a lake. There is no character in women’s faces before the age of thirty.” Honor‚ de Balzac

During the aging process, the face and neck succumb to the inexorable forces of gravity and inelasticity. This leads to a descent of the lid/cheek junction which creates a “tear trough deformity” or tired/hollowed look below the eyelid, loss of cheek volume and definition, increased nasolabial fold depth, sagging jowls, droopy eyelids and brows, prominent wrinkles and lines, and an ill defined, sagging neck. In order to combat the aging process and restore beauty, plastic surgeons summon a cavalry of invasive and non-invasive approaches.

Botulinum toxin, more commonly titled Botox, and soft tissue fillers have surfaced at a meteoric rate to impede the aging forces. Botox yields its effect by temporarily paralyzing muscles which can reduce or eliminate the dynamic lines around the eyes, forehead, eyebrows, and perioral regions. Soft tissue fillers such as Restylane, Cosmoplast, Hyaluroform, and Radiesse have emerged as potent tools to restore volume to the face and camouflage those impetuous wrinkles and grooves. Both Botox and soft tissue fillers are relatively safe and non-invasive and are a good phalanx of defense against the early signs of aging. However, their effects are temporary and mild and frequently need to be repeated and replenished every 6 months.

Chemical peels, dermabrasion and laser resurfacing remain popular and powerful instruments to tighten the skin, reorganize collagen in the dermis, eliminate fine wrinkles, improve complexion, and rejuvenate the skin. Recovery depends on the depth as well as the agent employed by the physician. They do not, however, tackle the sagging skin and laxity of the neck and face nor the jowl of the lower face and jaw.

These problems of laxity are best addressed by the standard facelift/necklift (or rhytidectomy). The facelift is an invasive operation that generally requires general anesthesia and significant downtime for recovery. In combination with a neck lift, its aim is to restore definition to the lower jaw, establish a more youthful neck without bands and sagging tissue, and rewind the skin to a more youthful form. The facelift does fail in treating midface aging where there is a hollowed area below the lower eyelid, loss of cheek volume and projection, and a deep, drooping nasolabial fold. A midface lift can correct these manifestations by elevating the depressed cheek/malar tissue and suspending it to the skull or temporal region.

All of these techniques can be executed individually or in tandem to achieve the ultimate result depending on the surgeon and patient. These strategies vary tremendously in cost, level of invasiveness, recovery time, and risk but they all possess the same goal: harmonious rejuvenation of the face.

If you are interested in learning more about facial rejuvenation, please attend my conference at the RWJ Hamilton Center for Health & Wellness on May 4 at 7p.m.

Alan Bienstock, MD, Plastic & Reconstructive Surgery, 630 Lawrence Road, Lawrenceville, NJ 08648. 609-977-9286.

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