Facial Ageing

As we lead packed days and weekends, with traveling and long nights, facial ageing is a common concern among patients. The subtle changes in our visage can be slowed down with an anti-ageing treatment plan in place. However, it is first important to understand the processes causing these signs of ageing we observe.

What Is The Triangle Of Youth and The Inverted Triangle?

The ‘Triangle Of Youth’ refers to the well-defined facial contours associated with youth. As we age and lose facial volume, our facial contours change, causing shadow patterns to develop while youthful highlights fade. The triangle becomes ‘inverted’.

As we age, our facial bone is resorbed over the years, just like the rest of our bones, and soft tissues fall due to gravity and lack of support. As a result, our facial tissues sag and droop downwards. Another key contributor is the shift in fat distribution across the face. Fat pads shift as we lose fats in some places, and gain fats in other areas.

For instance, we lose fats under the eyes, while fat pads beneath the chin can increase in prominence, causing fullness between the neck and chin, causing what is known as a “double chin”. The effort of the lower face getting fuller can be described as the ‘Pyramid of Age’, or ‘Inverted Triangle’.

What Happens In Facial Ageing?

Ageing occurs both in the skin layers, as well as beneath the visible skin. In fact, ageing occurs at every layer of the facial structure, including bone, muscles, connective tissue layers, fat pads and skin. The epidermis layer of the skin is on average 0.1mm thick (about the thickness of one sheet of paper). The dermis layer of the skin, averages about 1.5 – 2mm thick. With the skin being a very thin component of the face, all the signs of facial ageing can be attributed to the skin and every component of the facial structures.

Skin And Ageing

Youthful skin is soft, supple, smooth, well-hydrated, and rich with cells that renew relatively rapidly. As we age, we experience a loss of facial oil glands, which leads to less oil production and less moisture in the skin. We lose collagen and elastin, which can contribute to the formation of lines, such as laugh lines, frown lines and crow’s feet.

After repeated facial movement, these eventually become static lines that are gradually etched into the skin over time. Additionally, because our skin is less elastic, our face becomes more disposed to sagging.

Fats And Ageing

A youthful look depends on having the right amount of facial fats in the right places. Redistribution, accumulation and atrophy of fat lead to facial volume loss.

Areas which lose fat: forehead, cheeks, upper face
Areas which gain fat: mouth, jaws, lower face

This redistribution of fat pad deposits affect the contours of the face, and contribute to an illusion of downward sagging, disproportionate features and migration of features. Areas of fats tend to become further spaced apart, leading to an uneven appearance as separate structures, instead of a smooth, almost continuous layer.

Muscles And Ageing

Facial muscles lie beneath our facial fat pads. As we laugh, eat, smile and frown, repetitive muscle activity and loss of facial fat can contribute to wrinkles in the face. As a result, crow’s feet form at the outer corners of our eyes and creases form between our brows.

Altered facial proportions cause dyssynchrony in facial muscle movements, and undesired facial expression causes certain muscles to get stronger, whilst some muscles lose their tone over time. This loss of muscle tone and thinning skin can give the face a loose, sagging appearance. Our jawline loses its contour and our profile becomes less defined.

Bones And Ageing

Facial bones provide the foundation for muscle, fat pads and skin. This bone structure is what gives us our unique facial shape and contour. Youthful bone structure has full and high cheeks, as shown in the triangle of youth, and defined brow bones and less sunken eye areas. With age, we experience facial bone loss and changes in the dimensions and contour of our face. Reduction of facial bone mass causes the areas around our eyes to get larger, a decrease in our brow bone angle and a less sculpted jawline.

Which Treatment Options Can Address The Signs Of Ageing?

As ageing occurs in multiple layers of tissue, including bone, muscles, fat pads and skin, your aesthetic doctor will be able to assess and decide on a treatment option that is right for you. The first and essential step is to explore what signs of ageing are troubling you, before moving on to a diagnosis and the formulation of a suitable treatment plan. The goal of facial aesthetic treatments is to help restore facial volume and correct age-related shadow patterns inherent to the ageing face.

Topical Treatments

Since ageing of the skin comprises deterioration within all aspects: skin tone, texture, elasticity and hydration, topical treatments can help slow down the progression of superficial skin ageing and damage. However, there is little current evidence that topical ingredients are able to induce deep-seated changes that occur at the base of the skin or deeper.

Oral Supplements

Nutrient-dense oral skin health supplements may help tackle and slow down ageing processes in skin. Key ingredients that support skin health include antioxidants such as plant extracts, vitamins and essential minerals that are required for cellular metabolism. Consult our doctor to explore a suitable oral supplementation regimen. Find out more about the Evoleum oral skin supplements here.

In-Clinic Treatments

Hyaluronic Acid Fillers

They are designed for volume replacement of hollowed areas, such as disguising lines. An established method of non-invasive facial rejuvenation, patients typically achieve restoration of volume with minimal downtime with results lasting for 12 – 36 months.1 In-depth knowledge of blood vessel anatomy and proper injection techniques by the clinician, using suitable products, is necessary to reduce the risk of adverse effects.2,3 It is best to consult an experienced doctor with robust knowledge and training in the area of fillers. Dr. Vicki is an appointed official industry trainer by Allergan Medical Institute who teaches other doctors about scientifically backed techniques for facial volume restoration. She is also expertly trained in the advanced MDCodes method of filler injections, a precise, sophisticated and internationally renowned technique based on a deep understanding of facial anatomy. She was also the first doctor handpicked for rigorous training by the famous Brazilian cosmetic surgeon, Dr Mauricio De Maio who proposed and has published extensively on his approach in international medical journals. A study of 250 subjects and their scores given before and after treatment found that facial rejuvenation based on the MD Codes approach provides significant aesthetic improvements, with no major safety issues observed. 4 Read our treatment guide on hyaluronic acid fillers here.

Botulinum Toxin Injections (BTX)

BTX relaxes muscles to reduce repetitive facial expressions and lessen deep dynamic and static furrows. Multiple research studies over the years found that these treatments have a good safety profile.
Read our treatment guide on botulinum toxin injections here.

Red & Infrared LED Photodynamic Therapy

830nm and 633nm red and infrared light have been found in research studies to increase the amount of collagen and elastin fibers on microscopic examination. Studies demonstrated highly activated fibroblasts, surrounded by abundant elastin and collagen fibers.6PDT therapy is safe and painless with no adverse effects.

Lasers

Lasers resurface the epidermal and superficial dermal layers, encouraging the generation and remodelling of new collagen in the dermis and epidermis.7
Gold standard laser technologies for rejuvenation include erbium-doped yttrium aluminium garnet (Er:YAG) lasers8 and 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers. Scientific studies have shown significant improvement in skin texture and rejuvenation in study subjects.

Compared to ablative lasers, non-ablative lasers are typically associated with no serious adverse effects. Side effects were limited to minimal downtime in the form of transient redness and swelling. At VIDASKIN, we advise a personalized skin assessment for your doctor to plan on a suitable laser modality for your condition and therapeutic goals.
Read our treatment guide on the Laser Genesis treatment or enquire with our clinic about our signature Laser Medley program.

Chemical Peels

Peels can encourage epidermal regeneration, and new collagen formation with remodeling of fibres and deposition of glycosaminoglycans in the dermis.10 Peels can be classified as superficial, medium and deep according to depth of penetration. Results depend on the type of chemical used, its concentration, time of contact and more.11 A trained clinician can customise and modify the strength and timing of treatment
Read our treatment guide on the Cosmelan peel.

Micro Focused Ultrasound (MFU)

Different from high-intensity focused ultrasound (HIFU), microFU is very high intensity, focused ultrasound energy that creates thermal coagulation points in skin and subcutaneous tissues at 1.5mm, 3.0mm and 4.5mm depths. Not only has MFU been shown to stimulate long-term collagen regrowth (neocollagenesis)12, it also specifically targets the dermis or SMAS (a fibrous network of collagen, elastic fibers and fat cells that connects the dermis to the facial muscles, and is tightened during a facelift).13
At VIDASKIN, we use only the original, USA manufactured, FDA approved Ultherapy machine which also has a built-in Real-Time Visualisation function, that allows our doctor to see precisely beneath the skin, to ensure each treatment line is delivered at the precise layer, ensuring optimal results, and minimal side effects and complications.
Read our treatment guide on Ultherapy.

Monopolar Radiofrequency (RF)

RF delivers uniform heat to the dermis at a controlled depth to stimulate collagen and elastin fibres and tighten skin. A 2011 study of individuals over 3 months of treatments had their photos and skin biopsy specimens analysed. It was found that their skin had a significant increase in collagen types I and III, and newly synthesised collagen at the end of treatment.14
At VIDASKIN, we employ only Thermage FLX, an FDA approved treatment which has optimal efficacy, and treatments need only be done once every 1 to 2 years.
Read our treatment guide on Thermage FLX.

The goal of facial aesthetic treatment is to help restore facial volume, and correct age-related shadow patterns inherent to the ageing face. Your aesthetic doctor can decide on the treatment option that is right for you. Please consult your doctor for a personalised assessment and customised treatment program.

VIDASKIN Tips

How Else Do We Prevent Premature Skin Ageing?

Intrinsic ageing is inevitable. However, studies have shown that lifestyle modifications can help to maintain healthy cell function, such as minimising alcohol intake and refraining from smoking. Keeping a nutrient-rich diet high in fruits and vegetables, having sufficient sleep of 7-8 hours per day, regular aerobic exercises, all help to neutralise free radicals and filter toxic waste molecules in our body associated with the onset of premature ageing. Consult your doctor for research-backed lifestyle advice to slow down biological processes of ageing.

How often should I apply sun protection?

As a rule of thumb, every 20 units of SPF protection lasts for an hour. Hence, SPF 50 sunscreens would be ideal for 2 - 2.5 hours of direct sun exposure during outdoor activities. Reapply throughout the day when remaining under direct sunlight. Sun protection comes in the form of skin lotions and oral supplements for cellular antioxidant protection. Find out more about sun protective products here.

Authors:

Dr Vicki Leong, MBBS (Melbourne), MRCP (UK), Postgrad Diploma in Clinical Dermatology (Cardiff)
Dr Sarah Teo, MBBChBAO (Ireland)