The Aging Face: Analysis, Surgical Approach, and Result Assessment

Abstract

I recently heard a retired professor of plastic surgery offer a critique on a presentation showing preoperative and postoperative photographs of attractive young women who had undergone “rejuvenative” surgery. He remarked that in his opinion many of these women would have been better served by going on a fabulous vacation rather than going to the operating room. The point was well taken, but a dilemma still exists—what are the indications for surgery of the aging face? Indications to change acquired or congenital anatomy are more straightforward. Surgery such as rhinoplasty or otoplasty change rather fixed anatomic structures particular to each individual. Rejuvenation of the aging face is an entirely different matter. In contrast to rhinoplasty or otoplasty, no one needs surgery for “aging” changes when young. In its early stages, the onset of aging is insidious, making a discussion of indications for its improvement difficult. However, every human undergoes similar aging changes and every part of the human face reflects these changes. ### I. Analysis I approach each face lift candidate with the following philosophy: 1. Everyone ages in a similar way. Although individual variations exist, such as the amount of neck fat or eyelid skin, we all undergo congruent progressive changes from youth to old age. 2. Every part of the aging human face undergoes topographical changes that reflect changes in the deep anatomic structures—primarily a downward descent that is observed when one is in the upright position. These deep structures, or “pieces” of the aging face are inherent anatomic structures common to all. 3. To effectively and harmoniously rejuvenate the aging face, the plastic surgeon must reposition these multiple structures to their original youthful position. Excess tissue such as neck fat and muscle or upper eyelid skin must also be removed. In short, all movable components of the aging face must be surgically repositioned …