Rejuvenating Your Face

Options to restore your youthful appearance

By: Dr Bryce J Cowan BSc MSc MD PhD FRCS(C)

Facial rejuvenation is the term used to encompass all forms of restoring a youthful appearance to the face. It includes the broad categories of:

• Injectables (Botox® & fillers) (See BotoxFacts.ca for additional uses of Botox®);
• Resurfacing procedures (laser treatment, microdermabrasion & chemical peels);
• Surgical rejuvenation (brow lifts, eyelid surgery; facelifts, nose jobs, face and chin augmentation, and neck lifts);
• Topical tretinoin and tazarotene which reverse sun damage and enhance collagen production. (Learn about these acne treatments at AcneGuide.ca)

The normal changes associated with facial aging are the result of both:

• intrinsic (age related fat and bone loss known as atrophy, and skin laxity for example) and
• extrinsic factors (like ultraviolet light / sunlight, chemicals, and smoking).

These factors contribute to biological changes associated with age and create predictable patterns of facial change. An over-simplistic analogy is mimicked by the changes in the helium balloon your child wouldn’t let you throw away. With time there is loss of internal volume (gas in this example) and as a result the covering loses its taught shape, luster, and becomes wrinkled. Moreover, there is a marked change in shape of the entire structure. Naturally, similar changes on your face can be highly distressing especially since many available treatments are being promoted.

Physicians can treat facial aging three ways: through reduction (making the skin “fit”), augmentation (“stretching” the skin back to normal) or a combination of the two.

When it comes to choosing a rejuvenation procedure, the severity of the facial aging must be considered. Here’s a review:

• Wrinkles (individual fine or deep rhytids) are managed well by Botox® or injectable fillers. Although other agents are touted to produce similar results, Botox® is currently unsurpassed in its ability to soften or eliminate wrinkles caused directly by the action of underlying muscles of facial animation. (Botox Facts has more information for you)
• For wrinkles that may not be contributed to directly by facial movement or for depressed scars; superficial or deep fillers (ranging from collagen, hyaluronic acid and poly-L-lactic acid to silicone particles and bone cement and even your own injected fat). These can also be used for wrinkles, scars, and soft tissue augmentation (most commnly lip augmentation).
• When you have wrinkles involving larger areas or if it’s related to sun-damage, the underlying problem commonly lies in the biological changes in the skin itself. Here rejuvenation methods such as laser resurfacing, microdermabrasion, and chemical peels act to restore some of the lost intrinsic biologic properties of the skin and can provide a significant restorative change over these large areas. These treatments use light associated heat, physical sanding, or chemicals, respectively, to remove the surface layers of the skin and hence stimulate a regenerative-like process. Many common skin creams advertised to improve facial wrinkles contain glycolic or other acids used in light chemical peels to help improve the taughtness of your treated skin.
• As the severity of skin aging increases, injection and resurfacing procedures may be combined themselves or with surgical rejuvenation (possibly in a staged fashion).
• Surgical management of more severe forms of facial aging can be through an additive (implants), reductive (excisions or tucks), or combined approach. Modern rhinoplasties (“nosejobs”) are a good example where combined approaches of reduction by excision and augmentation through cartilage grafting are employed. As these procedures typically address changes in the three-dimensional volume (deep structures) and in the skin (envelope or cover) they obviously provide the greatest extent of rejuvenation and can address the greatest degrees of facial change. That said, they do come with a limited amount of scaring and the possibly some temporary numbness. Often these scars, created in lines of election, are fine and highly acceptable with some rare exceptions.
• Topical tretinoin and tazarotene can improve fine lines and the general appearance of the skin. The down-side is that you need to continue to use these topical treatments in order to maintain its effect. Sometimes, tretinoin and tazarotene can be combined with the procedures listed above to enhance the effects.

Although you may hear more and more about treating aging skin with the procedures and products mentioned above, we all know that the best form of care is through modification of your exposure to the extrinsic “modifiable” risk factors, like sun exposure (See Skin Cancer Guide for more information).

About the author:
Dr Bryce J Cowan BSc MSc MD PhD FRCS(C) (Reconstructive & Cosmetic Plastic Surgeon, The Skin Care Centre, Vancouver)

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