The sagging face....... PART 1 ( The Why?)

In my years of aesthetic practice, one of the most common complaints I have from patients is that they feel that their face is sagging. Most complain of jowls seen under the jawline making them look older. So they start consuming products to sort of enhance their collagen to improve the sagging skin but most products do not seem to work.

Before you can treat the problem, you need to understand what it is. As we age, our body undergoes a lot of changes in terms of anatomy and fat, muscle, or tissue redistribution. Here is a nice picture depicting the changes of ageing taken from The Journal of Facial Plastic Surgery Clinics of North America.

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1. Thinning of hair and receding hairline.

2. Forehead rhytids and ptosis.   ----> (Forehead lines and loss of volume)

3. Glabellar Rhytidosis.    ------>  ( Also know as frown lines)

4. Brow ptosis.

5. Temple rhytidosis and ptosis.

6. Upper lid redundancy and ptosis.   -----------> (Lid droop)

7. Lateral canthal rhytidosis.    -------------> (Crow's feet)

8. Nasal root rhytidosis.       ----------------> (Bunny lines)

9. Lower lid redundancy and rhytidosis    --------------> (Under eye wrinkles)

10. Lower lid fat pseudoherniation.     ---------> (eye bags)

11. Malar bag formation.                       ---------> (eye bags)

12. Cheek rhytidosis.

13. Periauricular rhytidosis.                  

14. Nasal tip ptosis and dependency.

15. Cheek sagging and fat atrophy changes.      ----------------> (face hollowness)

16. Deepening nasolabial crease                     ---------------> (laughing lines)

17. Facial rhytidosis and sagging.                  ---------------> (cheek wrinkles and sagging)

18. Perioral rhytidosis.  --------------------------> (perioral wrinkles or smoker's line)

19. Upper lid flattening and lengthening.

20. Thinning and atrophy of the vermillion (red lip)

21. Chin pad ptosis and retraction.

22. Jowl formation  ---------------------------> (jowls or face sagging)

23. Cervical rhytidosis    ----------------------> (Neck wrinkles)

24. Submental fat accumulation   ----------------->  (double chin)

25. Platysmal banding

26 Rhytidosis and midneck hollowing

27. Submaxillary gland ptosis.

I like this diagram because it covers all the possible facial ageing signs on a persons face. Yes, it is also a very ugly picture. Most people may have only 5 or 6 on the list after a certain age, but ageing is not just chronological. It also depends on your sun exposure, your lifestyle, nutrition, genetics, etc. 

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So what was once upside down triangle face that most people regard as youth, slowly, gravity starts pulling downwards until the triangle becomes bottom down. 

This image shows a more colourful and easier diagram than the first of what happens as we age. Our eye sockets appear bigger due to reabsorption of the bone and the shifting of the fat pads to either due to prolapse or loss of volume. The prolapse seen around the eye also is related to the increase laxity of the surrounding ligaments. Bags form around the eyes develop from laxity of the tissue surrounding it. Lines form on the face from loss of volume and movements that form expressions of the face. Combined with thinned out, unhealthy skin, it can look worst in some people.

So basically, the phenomenon of sagging of the face is not as easy as taking strings and pulling it to make you look tighter. It involves a more comprehensive knowledge and practical approach to getting the best results that is suitable for you.

Usually, my approach would be to see what bother's my patient most. And from there, we decide, what is the likely cause i.e. loss of volume in the temples or malar fat pads, reduce skin elasticity due to exposures to sun, over wrinkling due to over expressions, or other reasons that contribute to the sag look that the patient is not happy with. By explaining the cause of sagging, then only can the doctor prescribe the best form of treatment to a patient and whether surgical intervention is more likely a better choice in the patient's best interest.

So is there a treatment for sagging? 

The answer is, not a single treatment but more likely a series of combined treatment treating each and every problem located above. Honestly, looking at the above diagrams, most of us would have more than 1 issue. What is more important is to sit and discuss treatment options and costs and do a proper planning of how to achieve the best results.

I will continue in my next blog on what are the treatment options available to treat the sagging face.

For more questions or appointment enquiries please email to drmmclinic@gmail.com or msg us at 0123301585, or call 0321106608.

Sleep .......... Are we getting enough?

Travelling across time zones really messed up my normal sleeping pattern. But, come to think of it, I think I sleep better now compared to before, it is just that the timing is a bit off. Like sleeping early and waking up at 5, then falling asleep again at 8 and waking up at 10. But in terms of hours of sleep and quality of sleep, I think it has improved a lot since my last trip. The main focus is quality of sleep and getting that crucial 7.5 hours daily.

I was a victim of poor sleep hygiene like most workaholic city dwellers are. Plus, the intensity and demands of work previously when I was in the hospital were certainly not feasible. Imagine working from 7am to 5pm the next day. Yes, my houseman days in GHKL were super, the time we spent in the hospital was phenomenal. But we loved our job and our patients so much, most didn't even complain. We took it as part of the training to make us become more apt and precise in our decisions despite being under physical and mental duress. 

However, despite not being on-call anymore for the past couple of years, I found that I had a hard time switching off at night, and I wake up considerably easy. Turning off my phone was becoming an anxiety to me, and my late onset insomnia did not improve. I would wake up in the middle of the night and lie in my bed staring at the ceiling for hours unable to go back to sleep, only to doze off a few minutes before my alarm clock went off. It was draining my energy and causing my focus and concentration to wane. To some extent, I was getting a bit more depresses and irritable.

Many of us do not realise how sleep deprivation affects the body. Some people come to me and brag about sleeping for only 3-4 hours a day and able to function normally. (Are you sure?) Some people think its normal but many studies on human behaviour and sleep have shown that chronically sleeping less than 6 hours a day is detrimental not only to your physical health, but affects you mentally, emotionally and socially. 

So why is it important to get that good night sleep?

1) It affects your mood. 

    Lack of sleep causes irritability, lack of motivation, anxiety and depression.

2) Lack of Sleep makes people more prone to accidents.

    It is one of the leading cause of automobile accidents and occupational hazards.

3) It affects your intelligence and memory.

    Lack of sleep makes you forget things, and reduces your mental alertness to up to 32% if

    sleep deprived to less than 6 hours a day of sleep. It stunts creativity. It affects

    concentration, understanding, rationale thinking and problem solving processes.

4) It affects your sex drive.

    Studies have shown that lack of sleep reduces libido in both man and women. In fact, some studies also shows low levels of testosterone secretion in men deprived of sleep.

     

5) Lack of sleep ages your skin faster.

    Apparently beauty sleeps are not just an excuse to sleep early. People who are deprived of

   sleep for a couple of days have sallow skin and puffy eyes. Chronic sleep loss affects the skin worst    causing dark eye circles, formation of fine wrinkles and dull skin. Lack of sleep causes increase in      cortisol hormone levels that is also involved in the breaking down of collagen. 

6) Losing Sleep can cause you to gain weight.

  Most people believe that sleeping can cause you to be fat but actually the reverse is true.                Depriving yourself of sleep makes you gain more weight. A few studies conducted showed    that  people who lack sleep tend to consume more especially in the awkward hours thus  exceeding the  daily caloric requirements leading to weight gain. This was because lack of    sleep reduces the  secretion of leptin (your satiety hormone) and increases the production of  ghrelin (hunger hormone)  making people who sleep less than 6 hours a day experiencing  more hunger. The worst part is, lack  of sleep makes you crave for high fat and high sugary  foods. I think most people can relate to this.

7) Lack of sleep increases mortality risk.

  If you want to live longer, you should sleep more. As a hyperactive teenager, my dad use to  tell me  this. He wasn't too far from the truth. Studies have linked lack of sleep (i.e. sleeping  less than 6    hours a day) to be associated with increased risk of death to twice the risk  especially cardiovascular.

8) Sleep deprivation is associated to a lot of serious medical problems.

 There are many medical problems related to chronic sleep deprivation:

 a) Hypertension and high blood pressure

 b) Heart disease

 c) Heart Failure

 d) Irregular heart beats - arrythmias

 e) Stroke

 f) Obesity

 g) Diabetes

 h) Depression & other mood disorders

 i) Attention Deficit Disorder

9) It affects relationships.

  If your partner has sleeping issues and is deprived of sleep chronically, long term it will be a challenge for the you to cope especially when he or she has reduce mental performance,  less energy, low mood, lacking of motivation, low libido etc. In fact, he or she may start  influencing you to have reduced sleeping hours leading to your own problems. Your partner's sleep disturbances may disrupt your own sleep too.

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How much sleep should we have in 24 hours?

Most studies agree that an adult between 18-64 years old should try to get 7-9 hours of quality sleep everyday. Here is a beautiful chart courtesy of the National Sleep Foundation on different age groups and sleep recommendations.

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So, if you are sleeping less than the recommended hours, you better start deciding on trying to make more time for sleep. Some people have difficulty in falling to sleep or staying asleep. Others feel like they can sleep but does not have enough good deep sleep and keep waking up. Some people have sleep apnoea issues that causes them to have bad quality of sleep. Some people grind their teeth at night or wake up with muscle cramps. Although it may seem to be common, you should take to your health provider about any sleep disturbances you are experiencing because there are treatments available.

For more information or if you have any questions on sleep, please email to drmmclinic@gmail.com.