The Aging Face

A Question of Balance and Harmony


As we age we notice the firm, smooth, tight character that once defined our appearance begin to slip away. Volume is lost contributing to looseness of tissues and skin. There is a change in the underlying bony structure where rotation and resorption become evident in the eye socket, midface and jawline. Neck bands and jowls become prominent. The skin surface becomes pigmented, wrinkled and more roughly textured. The luminosity of youth departs.

Since we all age at different rates and in different ways, there is no universal age for a facelift. Timing is important for the most benefit possible. Once benefit from surgical enhancement is evident, it is best not to wait too long, yet it’s not advisable to do facial surgery before it is necessary.

Many non-surgical approaches are available for facial rejuvenation. Non-invasive energy-based technologies can help improve mild laxity. Facial fillers restore volume. Lasers improve skin texture and fine lines. It is doubtful however that facelifts will be relegated to surgical history anytime soon. A facelift is still the only repositioning and firming procedure that reliably lifts and tightens the face and neck and corrects the neck bands.

One of the key distinctions between a facelift and non-invasive procedures is that a facelift repositions and firms, but it does not add lost volume. A filler will add volume but is no substitute for tightening. Filling a very loose skin pocket will not result in an aesthetic outcome. In fact, there has been a paradigm shift. The very terms associated with bad facelifts—“overdone,” “tight,” “unnatural” can also be applied to inappropriate use of fillers altering facial shape in an obvious and unaesthetic way characterized by an overfilled, puffy, doughy appearance.


The importance of “appropriateness”

Whether surgical or non-surgical, my priorities are threefold: to maintain aesthetic proportions while staying age and person appropriate. And to synergistically combine surgical and non-surgical techniques in the right dose for an invisible result.

  • Aesthetic proportions – must be considered when restructuring the face, whether in surgery or otherwise, for harmonious features that are not off balance or distorted.
  • Staying age and person appropriate – Most would agree that wanting to look like a 25 year old at 50 would be absurd and it results in just that: “Wanting” to look like a 25 year old and not actually looking 25 years old. Features change. Looking like one did 25 years ago is not necessarily more attractive at an older age. The same volume that we had at 25 may not look good at 50. Recreating some features of youth is very different from duplicating the same look of a younger time. Whereas some volume repletion as we age looks great, too much of it, will look artificial and strange. The goal should be to look your best regardless of age and not to strive to look younger, just more youthful.
  • Aesthetic synergy – The secret is finding the right combination of tightening and volume and not using one to replace the other. The goal is a fresher, softer, and brighter version of our face in the mirror.

During your consultation

A consultation for facial rejuvenation and /or a facelift is necessarily comprehensive. First and foremost, it is a conversation about your motivations and who and where you are in your life cycle. In essence, it is to discuss what your goals are and what you are trying to accomplish.

Second, and one of the most important parts of the consultation, is to understand your aesthetics, and your particular concerns, so that we can work on that basis.

Third, you will also find it is as much a conversation about what a facelift can do as well as what it cannot do. A facelift does not replace lost volume. It will not change the skin’s texture or eliminate all wrinkles and lines. The good news is that there are adjunct procedures that complete the rejuvenation and might include fillers, laser treatments, fat grafting or ultrasound.

Another important and interesting part of the consultation is to get a sense of the aging process in your particular situation. Reviewing serial photographs from youth to the present time is a very helpful exercise and facilitates communication and planning, and is a part of each initial evaluation.