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.

Redensity II - Solution for tear trough

      Dark under eye rings can be such a nuisance to many of us. It makes you look tired, sick or just unhealthy. But some people are genetically prone to have rings under the eyes. Being Asian, we are predisposed to have a more prominent under eye problem due to the structure bone which is flatter than others. In Indians, we would see a hollower eye socket and thus appearance of the eye ring is more prominent especially with age and we start losing some of our malar fat. Look in the mirror and you will notice that the area next to your nose tend to appear flatter, and in some people there is a line. This is what you call a tear trough line.

Over the years, doctors have been using soft fillers to treat this problem. The light weight fillers give a satisfactory effect but only lasts approximately 3-6 months and the cost is high. Much sturdier fillers may cause lumps and bumps and not to mention the Tyndall Effect. 

What is Tyndall Effect?

The Tyndall effect, also known as Tyndall scattering, is light scattering by particles in a colloid or particles in a fine suspension. It is named after the 19th century physicist John Tyndall. It is similar to Rayleigh scattering, in that the intensity of the scattered light depends on the fourth power of the frequency, so blue light is scattered much more strongly than red light. An example in everyday life is the blue colour sometimes seen in the smoke emitted by motorcycles, particularly two stroke machines where the burnt engine oil provides the particles.

In relation to the tear trough, when fillers are placed beneath the thin skin, there is a chance of this effect occurring especially if the fillers are placed too superficially. The only way to remove it is by dissolving the filler with Hyaluronidase. However, even this does not guarantee 100% reduction of the Tyndall effect. Despite the fillers lasting less than a year, I have come across people with Tyndall effects lasting up to 2 years. Thus, in this case, cosmetic concealer would be prescribed. 

Hence my reservation in treating tear troughs in the past. I usually treat the malar area wmith fillers by replacing the lost of fat pads and volume. It gives satisfaction to most patients but there are those who require a little bit more. Thankfully since last year Teosyal came up with a filler designed especially just for tear trough - Redensity II.

Redensity II is a new age filler which allows thin area injection without causing Tyndall effect. It is a hyaluronic acid filler that is combined with a restructured complex of vitamins to tackle tear troughs, dark circles and fine lines around the eyes. It exerts minimal pressure on surrounding tissue giving the eye a homogenous, long-lasting and natural fill. A clinical study done on test subjects find that 100% of candidates would recommend this procedure to be done as it is quick, with minimal downtime (some none at all) lunch time procedure that gives satisfactory results.

But no matter how good the filler, the injector must be well-trained and have steady hands to give you the best result. It is a pretty forgiving filler which allows some room for error and will recorrect itself. Done by trained hands you will have minimal to no bruising. This service starts from RM 1500 / session and the effects lasts up to 12 months. I'm completely in love with this filler and now using blunt needles, this service is comfortable and gives wonderful results. The best look is after 2 weeks but immediately after you can see the difference.

For more information or appointments do contact us at 03-21440080 / 014-2233268 or email to faceworksclinic@gmail.com. You can also LIKE us on Facebook and send your enquiry through there.