Traditionally the belief has been that the changes which manifest on the face with aging are due to tissue (skin/muscle/fat) excess and sagging, and sun and environmental damage to the skin leading to wrinkles. This has led surgeons to approach facial surgical rejuvenation by cutting out the excess and re-draping the skin. While the factors mentioned are important components of why our faces change as they do when we get older – what most people don’t know is that loss of facial volume, primarily fat, but also bone, contributes immensely to father times effect on the face.
Think of it this way. When we are young we are all GRAPES – round, full and smooth. As we get older the skin of the grape thins, becomes dry and starts to wrinkle. In turn the shape of the grape becomes more like a football than a baseball. What really accelerates the process is that the grape shrinks and becomes a Raisin. The driving force behind this is loss of its internal volume or support. In the face this means loss of fat, reduced muscle strength and elasticity, and bone resorption (bone loss). Facial fat, bone and muscle give us support against gravity and other forces which enhance the aged appearance of the face.
The take home message is we still need to look at facial/eyelid surgery from the viewpoint removing excess when it exists. However, to truly restore youth we must aim at re-creating the Grape and fill with fat and facial fillers when appropriate. This is especially true with the eyelids.
Remember the goal is to look better and younger – not done.