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What happened to bright eyed and bushy tailed you? Aging, that’s what. With each birthday, the telltale signs of youthful days lounging in the sun sans SPF, eating a poor diet, or neglecting proper skincare, begin to show. Fine lines, wrinkles, and sagging skin are the most obvious signs, but other changes below the surface contribute to our aging appearance.

But how specifically does face shape change with age? Well, a study done at the University of Rochester, revealed when facial bone begins to thin, cheekbones beneath the eyes descend, offering less support. Eye sockets widen and become longer. Add to this the fact that facial fat, evenly distributed during youth (remember those perky, round cheeks?), begins to clump up and shift downward causing features that were formerly round to sink (University of Rochester).

Conversely, the lower half of the face adds fat, giving the appearance of being baggy around the chin and jowly around the neck. No bueno, especially since The Journal of Plastic and Reconstructive Surgery reports that jaw bone volume significantly decreases as a person ages, providing less structure for all that added fat to hang on to. Sagging skin, decreased chin projection and loss of jawline definition are a result. Um, great.

We turned to board certified facial cosmetic surgeon, Dr. Alexander Rivkin, MD, of Westside Aesthetics and Dr. Raphael Darvish, MD, MBA, of Skinpeccable, to get the full scoop on how our face shape changes with age and what can be done to prevent and combat these concerns.

Hyaluronic Acid Fillers
As things start to look deflated, and maybe a little saggy, fillers are your best bet. “When you are a teenager the focal point of the face is the eyes. As you get older and the face sags, the focal point of the face moves down and the more it moves down the older somebody looks,” says Dr. Rivkin. “One of the main goals is to try to replace some of that lost structure by using some more durable fillers to re-suspend the face. When we replace volume and lift the face physically but also lift up the face as perception, almost an optical illusion, we lift up the center focal point back up to the eyes and make someone look younger.”

Both Dr. Rivkin and Dr. Darvish recommend volumizing hyaluronic acid fillers, preferring Juvederm Voluma, to replace lost structure. “I like Voluma the best. It’s the thickest hyaluronic acid that we have commercially available to us right now and by being the thickest, it does last the longest. It’s a two year term versus one year for certain other fillers,” says Dr. Darvish.

Any differences between Juvederm Voluma and say, a shorter acting HA filler like Juvederm Ultra in terms of look or feel?
Dr. Darvish assures us, “They all feel very natural. The only issue is that the shorter acting fillers are put in a higher plane of the skin. The thicker longer lasting fillers, we don’t want to use anything too thick near the surface because maybe it can cause a little bump. So when its thicker we put it deeper.”

Not just for lost volume, filler is also great for wrinkles…
“By filling in smile lines and marionette lines with hyaluronic acid fillers it looks like your face is tighter and fuller,” explains Dr. Darvish, “ And the benefits of hyaluronic acid fillers are cumulative. Filler does stimulate your own collagen so in addition to acting as a filler and adding volume it is also triggering the natural collagen production of your body. It’s a two fold improvement.”

And what if we don’t like how the filler looks?
“The great thing about hyaluronic acid fillers, they’re 100% reversible,” explains Dr. Darvish. “God forbid you are the one in a million patient that has a problem or reaction with Voluma, we can put a solution called hyaluronidase into the treatment area. It’s an enzyme that breaks down hyaluronic acid. So you will never end up in a situation where you are not happy with the filler because you can always reverse it.”

Lasers, Micro-needling & Microdermabrasion
“Other things one can do,” says Dr. Darvish, “short of fillers is fractional lasers that will stimulate some collagen growth, microdermabrasion and micro needling can help.”

Fractional lasers – the gold standard for the past ten years in cosmetic dermatology, targets small areas leaving surrounding areas of skin untouched, resulting in faster recovery. Improved skin elasticity, texture, fine lines, acne scars and sun damage are just a few of the benefits.

Micro-needling – sounds scary (uh, needles?), but it’s actually much less invasive than fractional lasers. Micro needling involves the use of a device that contains microscopic fine needles that puncture the skin and create a controlled skin injury triggering the body to fill these microscopic wounds by producing new collagen and elastin.

Microdermabrasion – the least invasive of the three and the most popular since it’s relatively less expensive, uses gentle abrasion and exfoliation to smooth wrinkles, fine lines, reduce the appearance of scars and brighten skin tone. By removing a top layer of skin, microdermabrasion stimulates the body to increase cell turnover and produce collagen.

Any good anti-aging products you recommend for at home use?
Prevention really is key. Aside from wearing a daily SPF, “Vitamin C and retinol are the good mainstay ingredients that work fantastically and are available in any dermatologist offices. There are other products commercially available by Skinceuticals. They sell Resveratrol B E and CE Ferulic. These are two anti-aging products that will help to stimulate collagen and elastin; the soft tissue structures that are a part of the matrix that keep our skin looking fresh and young,” says Dr. Darvish.

Disclaimer: Any information in the publications, messages, postings or articles on the website should not be considered a substitute for consultation with a board-certified dermatologist or plastic surgeon to address individual medical needs. Your particular facts and circumstances will determine the treatment which is most appropriate for you. And the outcomes.

Read about the fastest growing cosmetic procedure – labiaplasty – and why women are getting what’s been dubbed the “vaginal facelift” after having children.

-by Amy Chang
Photographed by author

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