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.

Radiesse Workshop......

Last Sunday, I was at Pantai Hospital, Bangsar for the Radiesse Workshop organized by Servicom. The guest speaker was Dr Peter Huang, a well-known aesthetic plastic surgeon from Taiwan. It was my second encounter with Mr Huang, and both times I have been very impressed with his technique and work. Previously, it was a workshop on hyaluronic acid fillers, this time its Radiesse.

What is Radiesse? Radiesse is also a type of filler that you can inject into the face to fill up spaces or add volume to areas you need adding. It is made out of calcium hydroxypatite, which is almost equivalent to your bone. Compared to hyaluronic acid (HA) fillers (such as Restylane, Juvederm, or Teosyal) Radiesse is much harder and last approximately 15-18 months.

It is really good for nose bridges, because it does not expand as much as HA fillers do and it lasts longer. It can also be used for chin, nasolabial folds, marionette lines and for midface areas and enhancing cheek bones.

The injections are similar to HA technique where ideally you are given nerve blocks or analgesia to reduce pain initially. The process takes around 15 minutes to 1/2 an hour depending on how many areas you are doing. In terms of pain, some say that it is more painful than HA fillers, but nothing unbearable, and its only for a few hours after the blocks run out. Swelling is more than HA and usually it goes off after 2-3 days. Bruising is a complication and you may consider having the procedure done during the less busy days just in case, or use concealer if needed. The filler is soft and moldable within the first week - but I would usually ask my patients to wait until the swelling is gone before they try to remould the filler. Top-ups usually 2-4 weeks later, depending on suitability.

The only down side of it, is that you can't remove it once its in - so I would suggest that unless your mind is already set on having the filler done, you should keep to HA fillers which lasts shorter and can be dissolved with hyaluronidase. Another more important aspect is to be confident with your doctors injecting skills, which would make a difference to the outcome.

Interested to know more? You can email me at info@faceworksclinic.com or book an appointment for a chat at Faceworks Clinic - Tel : 03-21440080.