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Month: February 2021

Introduction To Facial Aging

Introduction To Facial Aging

Clues to Facial Aging (The Aging Face)

Major forces responsible for facial aging include gravity, sun damage, soft-tissue aging smoking, changes in facial muscular activity, and skeletal remodeling.

Characteristic signs of facial aging include:

  • Greater visibility of tiny blood vessels in the skin, due to thinning of the dermis
  • Greater visibility of bony landmarks, like jutting cheekbones or chins, secondary to facial fat involution
  • Hollowing of the mouth and the cheek area due to dental and bone loss, and loss of fat (volume depletion)
  • Descent of facial fat pads due to deepening of the nasolabial folds and gravity
  • Flattening of the philtrum and thinning lips
  • Decreased support of the lower third of the face
  • Drooping of the nasal tip

Youthful Brow vs Aging Brow

The brow of the young woman on the left is free of lines and wrinkles. The brow of the woman on the right demonstrates the parallel lines, forehead creases, and brow descent characteristic of aging.

Youthful Eyes vs Aging Eyes

The following photos of the 22-year-old woman on the left and her 51-year-old mother on the right are examples of the changes caused by aging.

The woman on the left has a smooth contour of the eyelid skin, whereas with aging there is excess upper eyelid skin, depressions (nasojugal folds), and wrinkling giving an uneven appearance of the lower lids. Fat herniation and dark circles may also be present.

Youthful Lips vs Aging Lips

The lips of the woman in the left photo are a visible sign of youth. They are full-bodied and smooth. Usually, at the age of 35 or more, our lips will start to thin out and flatten. The corners of our mouth will also begin to droop, as well as lip lines will begin to appear. These changes are beginning to be evident in the photo of the woman on the right.

 

Youthful Mouth vs Aging Mouth

The mouth area shows dramatic change during the aging process. The photo of the young woman on the left demonstrates the volume of youth. In contrast, the photo of her mother on the right shows a deepening of the nasolabial folds and corners of the mouth, as well as skin relaxation of the sides of the mouth.

Youthful Malar Area vs Aging Malar Area

The cheek contour and volume of the woman on the left are characteristic of youth. As early as 30 years of age, some descent of malar fat can be observed, which eventually leads to sagging of the jowl and deepening crevices (cheek). These characteristic changes of aging can be seen in the photo of her mother on the right.

 

Signs of Aging in the Upper Face

  1. Brow descent
  2. Hanging upper eyelids
  3. Excess skin upper eyelids
  4. Crow’s feet
  5. Loss of support of the outer angle
  6. Scleral show (excess show of the white of the eye)
  7. Fat herniation, lower lids
  8. Malar groove (depression outer lower eyelid)
  9. Malar (cheekbone) hang
  10. Nasojugal groove (depression inner lower eyelid)

 

Signs of Aging in the Lower Face

  1. Nasolabial fold
  2. Nasolabial groove
  3. Hanging corner of the mouth
  4. Lateral mandibular groove
  5. Prejowl depression
  6. Jowling
  7. Loss of volume lower lip
  8. Flattening of upper lip due to loss of volume
  9. Chin crease
  10. Loss of dental support

 

Facial Skin Aging

 

We begin to age the moment we are born, and the normal physiologic changes as we grow older can result in loss of volume (involution), or the progressive degeneration of the skin.

The combination of involution and thinning (aging) or the thickening (sun damage) of the skin often leads to skin problems, such as surface roughness and uneven contours of the face, sometimes called the “hills and valleys” of aging.

Extrinsic aging, caused by environmental damage, disease, or weight alteration, combined with intrinsic aging, caused by chronologic or ethnic factors, can result in a variety of skin imperfections. These imperfections (whether they are wrinkles, age or “liver” spots, acne scars, or other skin rhytids) may be uncomfortably noticeable. Today, a variety of different methods—including injections and physician-strength skincare products—can be used to produce smooth, clear skin and younger-looking facial contours.

 

Old Age = Lost Volume

We continue to lose volume in the face as we grow older—the flesh loosens and stretches and the wrinkles multiply.

Volume Loss

The aging process continues as the layer of fat under the dermis erodes and the muscles underneath the fat weaken and lose elasticity and tone.

These changes manifest themselves most notably as loss of volume (ie, thinning of the skin, drooping of mouth corners, jowling).

As We Age, Repetitious Muscle Movement Causes Wrinkles

Our emotions—anger, grief, happiness—are stamped on our faces by the repetitious movement of our facial muscles. Over time, this can result in facial wrinkles.

Important muscles of the face include:

  1. Frontalis: raises the eyebrows
  2. Corrugator: draws eyebrow downward and medially
  3. Procerus: forms a horizontal crease in the bridge of the nose
  4. Orbicularis oculi: closes eyelids, aids passage and drainage of tears
  5. Orbicularis oris: narrows mouth orifice, purses lips and puckers lip edges
  6. Depressor Anguli Oris: pulls the corners of the mouth down causing marionette folds
  7. Platysma: depresses the lower lip and forms ridges in the skin of the neck and upper chest

 

Muscle Activity and Horizontal Forehead Lines

When we’re surprised, puzzled, or alarmed, we tend to raise our eyebrows. The contraction of the frontalis muscle can, over time, result in permanent horizontal forehead lines.

Muscle Activity and Glabellar Frown Lines

The wrinkles between the brows—glabellar frown lines—are caused by the contraction of the corrugator and procerus muscles. As skin becomes less elastic over time, repeated contraction of the corrugator and procerus muscles may “crease” the skin, creating lines and wrinkles that are visible even when the muscles are at rest.

Muscle Activity and Crow’s Feet

Crow’s feet are caused by the movement of the orbicularis oculi. Over time, repeated contraction of this muscle may also create visible wrinkles—even at rest.

Muscle Activity and Perioral Lines

Perioral lines are the result of repeated contraction of the orbicularis oris sphincter of the mouth. They are exacerbated by the ageing process and by smoking.

Muscle Activity and Mouth Frown

The depressor anguli oris pulls the corners of the mouth down causing marionette folds. Repeated contraction of this muscle leads to a permanent “sad” look.

Muscle Activity and Platysma Bands

The platysma depresses the lower lip and forms ridges in the skin of the neck and upper chest when the muscle contracts. Contraction of the platysma can convey the emotions of stress and anger.

Can We Use Fillers to Replace the Volumes Lost to Aging?

dermal filler for facial

Yes. Today, instead of merely eliminating aging lines and crow’s feet, injections of filler substances may provide you with a fuller, more youthful-looking face with high contours and smooth skin. Injectable fillers can dramatically.

Looking for the best form of facials Singapore or the best anti-wrinkle treatment in town? Now people have too many places to choose from to find the best filler injectors.

Some of the popular outlets for facials with details of their recommended facial treatment in Singapore are:

  • My Cozy Room (Premium Extraction Facial)
  • La Source Spa( La Radiance Facial)
  • Derma Lab ( Premium Anti-aging facial)

Breast Implants Removal and Replacement

Breast Implants Removal and Replacement

Introduction to Breast Implants Removal & Replacement

With the ageing of implants, more women are electing to have their implants replaced with new ones or removed entirely. The removal and replacement of implants or removal of breast implants without replacement is a safe operation with few to no complications and a rapid recovery. The duration of the operation is around an hour or so. You can expect mild to little pain after the procedure.

For breast implant replacement, patients can choose to use either silicone gel or saline implants regardless of the type of implant that was originally inserted. The new breast implants are likely to be in the same area as in the previous breast implants. Breast implants can also be removed with very little to zero deformity.

As with any operation, safety and the recovery period are of concerns to most patients. The replacement & removal of breast implants is a safe surgery that is usually done under anaesthesia or sedation. The patient’s vital signs are monitored by the anesthesiologist.

A long-acting local anaesthesia is placed into the previous scar to make the recovery more comfortable. Once the breast implant pocket is exposed, bimanual examination (fingers on the outside are pressed against fingers in the pocket) is done to detect tumours.

Usually, the old breast implant is removed and a new one placed into the same pocket. Often no further manipulation of the pocket is needed.

Post Breast Implant Replacement Surgery

Once in the recovery room, patients are monitored by the recovery room nurse. There is usually very little pain from this surgery, and even the incision is comfortable because of the long-acting local anaesthetic that has been placed. Patients prone to nausea from anaesthesia usually do well because all patients receive a scopolamine patch behind the ear. Medication is available for those who struggle with nausea.

The surgery for replacement or removal of breast implants usually takes about an hour or less and the time in the recovery room is usually two hours prior to discharge. Vital signs continue to be monitored during this time by the nursing staff.

It is best to wear loose-fitting clothes for the return trip home. Patients are advised to rest after the surgery and because of the anaesthetic not to drive for the first 24 hours. A caregiver must be present for the first 24 hours which adds to the safety of the surgery.

Complications From Breast Implants Removal or Replacement

Complications from removing and replacing breast implants or simply removing breast implants are practically unheard of. For the most part, the original breast implant pocket is unchanged making this a fairly easy operation with little discomfort. When the original breast implant pocket needs to be altered, even this carries with it a few complications.

Incision for Replacement of Breast Implant Surgery

Usually, the breast implant replacement incision is at the original incision location. You can expect the healing to be in a similar fashion to the previous augmentation mammaplasty The most common incision is in the mammary fold. When the saline implant is replaced by a silicone implant, the incision needs to be extended.

Over vs. under the muscle

Augmentation mammaplasty may be done above or below the pectoralis major muscle (“over’s” and “under’s”) with the use of saline or gel-filled implants. The location and the type of implant has an effect on how the breast implants feel and look. There is generally no timeline when implants need to be replaced except for the older Mentor “low bleed” gel implants of the 1980s with shells that were manufactured too thinly.

Since the early 1980’s most breast implant surgery is performed in the under the muscle, subpectoral location. Augmentation mammaplasty performed this way has been shown to have fewer complications. There are less bleeding and less potential deformity from capsular contracture using what is medically known as the subpectoral approach for breast enlargement surgery.

Saline vs. silicone breast implants

It is easy to make an exchange from saline breast implants to silicone implants, as it is also easy to remove silicone breast implants and exchange these for saline implants. The placement of silicone gel implants requires a larger incision than saline implants, but here too the incision can be expected to heal well.

The incision for silicone breast implants is usually in the submammary fold. Most patients requesting removal and replacement of implants tend to choose the silicone implants because of the more natural appearance and feel of these breast implants.

Augmentation mammaplasty with saline breast implants

There is no specific duration as to how long saline implants will last. With time one can expect a certain amount of wear and tear especially when wrinkling of the implant can be felt which can create areas of weakness of the breast implant leading to leakage.

Generally, when a saline breast implant fails, the entire implant deflates, and the patient becomes aware that one side has become smaller than the other. It is unusual to have both sides fail at the same time and also unusual for a partial deflation. Deflation is more common if the implants are underfilled because wrinkles are more likely to form leading to failure. This is the primary reason I like to overfill implants. When a patient needs replacement of one breast implant, it is generally best to replace both implants at the same time.

Larger breast implants can be used to replace the original smaller breast implants. Generally, the tissues take up quite nicely and patients are more comfortable with the smaller implants. For any of the exchanges, saline or gel-filled implants can be placed.

More and more women are opting for the gel-filled breast implants. They most resemble normal breast tissue and usually, the implants cannot be felt. This is in contrast to saline breast implants which feel more like a water-filled balloon. Nevertheless, there is a high rate of satisfaction with either type of breast implant.