Signs Of Facial Aging Research Articles

Exploring the effectiveness of a new generation of collagen-stimulating fillers

Volume loss is one of the first signs of facial ageing and dermal fillers have become an increasingly popular cosmetic intervention for this indication. Collagen-stimulating fillers are a safe and effective treatment for restoring shape and redefining contours. Ian Strawford explains the mechanism of action of the Ellansé dermal filler range and shares three patient case studies

A comparison of self-reported signs of facial aging among women in Australia vs. those in the United States, United Kingdom, and Canada

A comparison of self-reported signs of facial aging among women in Australia vs. those in the United States, United Kingdom, and Canada

Fine Lines: cosmetic advertising and the perception of ageing female beauty

Fine Lines is a study investigating the language used in adverts for female facial cosmetics (excluding makeup) in UK Vogue magazine. The study queries whether this has been affected by the introduction and rise in popularity of minimally invasive aesthetic procedures to alleviate the signs of facial ageing. The contemporary cultural landscape is explored: this includes the ubiquitous nature of advertising as well as the growth of the skincare market. Emergent thematic analysis of selected advertisements showed a change in the language used before the introduction of the aesthetic procedures (1992 and 1993) compared with later years (2006 and 2007). We have noted a decline in numbers of advertisements within some themes (nourishing in particular showed a marked fall in number of mentions) while others have shown increases (those offering protection against UV radiation and pollution increased by 50% in the later data set). The remaining thematic categories were relatively constant over the period of study, though the emphasis shifted within the themes over time. This article concludes by asserting that the language has changed, that the vocabulary has become more inventive and that skincare products appear to be marketed as complementary to cosmetic procedures. In addition, some of the products appear to be being marketed as luxury items, something to be bought because owning and using it gives you pleasure and bestows prestige on the owner.

The Facial Adipose Tissue: A Revision

Recent advantages in the anatomical understanding of the face have turned the focus toward the subcutaneous and deep facial fat compartments. During facial aging, these fat-filled compartments undergo substantial changes along with other structures in the face. Soft tissue filler and fat grafting are valid methods to fight the signs of facial aging, but little is known about their precise effect on the facial fat. This narrative review summarizes the current knowledge about the facial fat compartments in terms of anatomical location, histologic appearance, immune-histochemical characteristics, cellular interactions, and therapeutic options. Three different types of facial adipose tissue can be identified, which are located either superficially (dermal white adipose tissue) or deep (subcutaneous white adipose tissue): fibrous (perioral locations), structural (major parts of the midface), and deposit (buccal fat pad and deep temporal fat pad). These various fat types differ in the size of the adipocytes and the collagenous composition of their extracellular matrix and thus in their mechanical properties. Minimal invasive (e.g., soft tissue fillers or fat grafting) and surgical interventions aiming to restore the youthful face have to account for the different fat properties in various facial areas. However, little is known about the macro- and microscopic characteristics of the facial fat tissue in different compartments and future studies are needed to reveal new insights to better understand the process of aging and how to fight its signs best.

Platelet-rich plasma and hyaluronic acid - an efficient biostimulation method for face rejuvenation.

Cosmetic applications of platelet-rich plasma (PRP) are new, and reports are scarce and dispersed in the literature. There are a variety of commercially available kits and injection techniques, and the number and intervals of injections vary. New investigations should focus on developing a standardized procedure for PRP preparation and application methods to augment its efficacy and potency. In this report, we aim to provide data and commentary to assist and add to current guidelines. A series of 94 female patients with varying degrees of facial aging signs were treated with PRP and hyaluronic acid (HA). Mean age was 53.0 ± 5.6. The mean injection number was 3.6 ± 2.0. Platelet-poor and platelet- rich plasma parts were mixed with 0.5 cc %3.5 hyaluronic acid and 0.5 cc procaine and injected with a 30G, 13-mm needle into deep dermis and hypodermis. Patients were asked to rate their personal satisfaction with their skin texture, pigmentation, and sagging. In addition, the overall results were rated by three independent physicians and the patients themselves. The outcomes were peer-reviewed, and correlations between the degree of the aesthetic scores and the number of injections were explored. There was a statistically significant difference in general appearance, skin firmness-sagging and skin texture according to the patients' before and after applications of PRP. A statistically significant correlation was found between the number of injections and overall satisfaction. Compared to the baseline, the PRP and HA injections provided clinically visible and statistically significant improvement on facial skin. The improvements were more remarkable as the injection numbers increased.

Anatomical Basis for Safe and Effective Volumization of the Temple.

One of the earliest but often unaddressed signs of facial aging is volume loss in the temple. Treatment of the area can produce satisfying results for both patient and practitioner. Safe injection requires explicit knowledge of the anatomy to avoid complications related to the multitude of vessels that course throughout the region at various depths. The authors aim to detail the anatomy of the area and provide a safe and easy-to-follow method for injection. The authors review the relevant anatomy of the temporal region and its application to cosmetic filler injections. The authors describe an easy-to-follow approach for a safe and effective injection window based on numerous anatomical studies. Injection in this area is not without risk, including potential blindness. The authors review the potential complications and their treatments. Hollowing of the temple is an early sign of aging that, when corrected, can lead to significant patient and practitioner satisfaction. Proper anatomically knowledge is required to avoid potentially severe complications. In this study, the authors present a reliable technique to safely and effectively augment this often undertreated area of the aging face.

Women's attitudes to beauty, aging, and the place of cosmetic procedures: insights from the QUEST Observatory.

The quest for beauty has been a constant theme in human history since the earliest civilizations. The QUEST Observatory, an online observational study, investigated how women continue the pursuit of beauty in the 21st century by examining women's perceptions of facial attractiveness and the strategies they adopt to combat the effects of time on their faces. To investigate women's attitudes toward beauty, aging, and the place of minimally invasive cosmetic procedures and anti-aging skincare. An in-depth questionnaire was developed by experts in dermatology, esthetic medicine, and social anthropology as the basis for this online, observational study. A nationally representative sample of 1000 French women aged between 25 and 70 years took part in the study. The main criteria for beauty were identified as a natural look, self-confidence, and attractive skin. A woman is considered to be at the peak of beauty in her mid-thirties just before early signs of facial aging begin to appear. Approximately 50% of women contemplate cosmetic procedures, but less than 10% go ahead. Confidence in the practitioner and good postprocedure follow-up are as influential as efficacy, safety, and cost in decisions about cosmetic procedures. The QUEST Observatory sheds valuable light on factors that affect women's choices regarding strategies for anti-aging and cosmetic procedures. These findings will help esthetic practitioners to better understand their patients and to meet their expectations.

Therapeutic approaches for the treatment of facial aging

Over the last few decades, a magnitude of novel therapeutic approaches to battle the signs of facial aging have become available in esthetic dermatology. Comprehensive research in this area has significantly improved our understanding of the anatomy and physiology of facial aging. In order to successfully address age-related alterations in the human face, today's anti-aging treatment frequently necessitates multifaceted options. Alongside botulinum toxin and fillers, a plethora of different modalities are currently available to complete our esthetic portfolio, which are discussed in this review.

Solar exposure(s) and facial clinical signs of aging in Chinese women: impacts upon age perception.

A new reference clinical atlas of facial signs dedicated to photoaging was applied to 301 Chinese women of various ages through standardized photographs. Such approach aimed at better describing the facial changes induced by both real/chronological age and sun exposure and their respective impact on two subcohorts of different behavior with regard to sun exposure. A total of 28 various facial signs were individually graded according to their severity by a panel of experts, and a perceived apparent age of each subject was assessed. Results showed that the severity of major signs significantly increased rather linearly with age, with a higher rate in sun-exposed subjects as compared with subjects who regularly avoid sun exposure. The severity of facial signs, all impacted by sun exposure, better correlated with perceived apparent age than real/chronological age. The protocol used in the present work, similar to that previously applied to two cohorts of French women, assigned a greater impact of sun exposure in the facial aging signs of Asian women – all clinical signs are influenced by extrinsic factors – as compared with Caucasian women of comparable ages, likely related to much more intense ultraviolet (UV) radiation.

Neck Rejuvenation with Mastoid-Spanning Barbed Tensor Threads (MST Operation)

Face rejuvenation with barbed tensor threads has been used in a variety of techniques by many authors focused mainly on cheek rejuvenation. Nevertheless, there is a scarcity of detailed techniques and descriptions of surgical steps in barbed-thread neck rejuvenation. Here we describe our technique and analyze the results of this approach to minimally invasive neck rejuvenation with barbed threads. The main aspect of this technique is placement of a mastoid-spanning barbed thread, which deepens the cervicomental angle and provides more tension than other techniques that use barbed threads but that do not cross the neck midline. A retrospective study was conducted on a group of 67 consecutive cases who underwent this technique in a 34-month period starting in August 2009. The patients' average age was 48 years old and the average follow-up was 18 months. Patient satisfaction was high as evidenced by a minimal request for secondary operations. Complications were few and mild, with no cases requiring reoperation for thread removal. The study showed that neck rejuvenation with barbed threads that cross the neck midline is a powerful minimally invasive rejuvenation technique. The best indication is in patients with initial signs of facial aging. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Hyaluronic acid: essential properties and considerations for aesthetic practice

Generally, by the age of 30 years, structural changes start to become noticeable on the face. The redistribution of fat, combined with both the loss of bone and soft tissue volume and decreased dermal elasticity and thickness, contribute to the formation of fine lines, wrinkles and folds. In the past, surgical procedures were the dominant method for tackling signs of facial ageing. However, this two-dimensional technique is giving way to the three-dimensional volume restoration that dermal fillers provide. Hyaluronic acid (HA) is present among all living organisms and plays an integral part in the maintenance and regulation of moisture within tissues, due to its high affinity for water. There are a number of factors affecting the properties of each HA-based filler on the market, including molecular weight, cross-linking, swelling, modulus and particle size and distribution. Each dermal filler is appropriate for different areas and types of treatment. Although there is no single filler that is appropriate for every type of treatment in all patients, correct adjustments of the above properties could lead to the production of a more ‘ideal’ dermal filler.

Effect of the sun on visible clinical signs of aging in Caucasian skin

ObjectivesAging signs can be classified into four main categories: wrinkles/texture, lack of firmness of cutaneous tissues (ptosis), vascular disorders, and pigmentation heterogeneities. During a lifetime, skin will change in appearance and structure not only because of chronological and intrinsic processes but also due to several external factors such as gravity, sun and ultraviolet exposure, and high levels of pollution; or lifestyle factors that have important and obvious effects on skin aging, such as diet, tobacco, illness, or stress. The effect of these external factors leads to progressive degradations of tegument that appear with different kinetics. The aim of this study was to clinically quantify the effect of sun exposure on facial aging in terms of the appearance of new specific signs or in terms of increasing the classical signs of aging.Materials and methodsThis study was carried out on 298 Caucasian women from 30 years to 78 years old. The participants were divided into two groups according to their sun exposure history: 157 women were characterized as sun-seeking, and the other 141 were classified as sun-phobic. This division was made possible by dermatologist grading of heliodermal status on the basis of several observations of classic criteria: wrinkles, sagging, pigmentation heterogeneities, vascular disorders, elastosis, and so on. This work was an opportunity to complete clinical photographic tools by adding in our portfolio new scales for signs observed in the two groups. Thus, 22 clinical parameters were investigated by a panel of twelve trained experts to characterize each woman’s face regarding standardized photographic scales, and thus describe the aging process.ResultsBy calculating statistical correlations between the four clinical clusters (wrinkles/texture, ptosis, vascular disorders, and pigmentation disorders), and real age and apparent age on the one hand and heliodermal status on the other hand, we identified a link between each clinical cluster and aging and the photoaging process. By comparing evaluations of clinical signs between the two groups for each 10-year cluster, we demonstrated that whatever the age, a prevalence of pigmentation disorders for the sun-seeking group (ie, pigmentation) is strongly linked to ultraviolet (UV) exposure. Meanwhile, clinical signs of ptosis are linked more to chronological aging and do not present differences between the two groups, nor, therefore, photoaging. Wrinkles and texture are affected by the two aging processes. Finally, clinical signs of vascular disorders present no evolution with age.ConclusionClinical signs of aging are essentially influenced by extrinsic factors, especially sun exposure. Indeed UV exposure seems to be responsible for 80% of visible facial aging signs.

Assessment of Quality of Life in Patients Who Underwent Minimally Invasive Cosmetic Procedures

There are increasingly more patients seeking minimally invasive procedures, which have become more effective and safer in reducing the signs of facial aging. This study included 40 female adult patients who voluntarily underwent selected minimally invasive procedures (filling with hyaluronic acid and botulinum toxin injection) for facial rejuvenation. All patients were followed for a period of 6 months. They were evaluated with the use of questionnaires, a quality-of-life questionnaire (DLQI), the self-esteem scale of Rosenberg (EPM/Rosenberg), and a pain scale. The minimally invasive procedures resulted in improvement in quality of life and self-esteem, which were stronger the first 3 months after the procedures but remained at a higher level than that before treatment, even after 6 months. Hyaluronic acid with lidocaine in the formula is more comfortable for the patient as it makes the injection less painful. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Use of a neuromuscular electrical stimulation device for facial muscle toning: a randomized, controlled trial

Age-related loss of muscle mass contributes to aging of the human face. To evaluate the effects of a neuromuscular electrical stimulation (NMES) device on facial muscle tone and signs of facial aging in healthy women. One hundred and eight healthy women (mean age 43.7, range 32 to 58-45 years) participated in this randomized, controlled, partially blinded study. Participants were randomized to 12 weeks' treatment with the NMES facial device (20 min/day, 5 days/week) or to a nonintervention control group. Participants could not alter fitness, diet or facial care routines during the study. Assessments included psychometric evaluations of facial appearance and assessor-blinded ultrasound measurements of the thickness of the zygomatic major muscle. Mean muscle thickness increased vs. baseline in the NMES group (18.6%) but not the control group. Between-group differences were significant at 6 and 12 weeks (P = 0.05 and P = 0.0001). NMES users reported subjective improvements in facial attributes. The control group did not. In an overall evaluation, ≥80% of NMES users reported improved firmness, tone and lift vs. <5% of the control group (P < 0.001). A 12-week course of facial NMES was associated with increased thickness of the zygomatic major muscle and subjective improvements in facial attributes.

Traitement des plis d’amertume par section du depressor anguli oris : note technique

Marionette folds are typical signs of facial aging. They result from contraction of depressor anguli oris (DAO) muscle, which tracts the corner of the mouth inferiorly and laterally. Marionette folds express sadness, contrary to the real mood of patient, and constitute a purpose of consultation. A systematic classification of facial aging types has been developed by Glogau in 1994. It differentiates four types of wrinkles according to their severity. Type IV of marionette folds resists to treatment with filler injection or botulinum toxin type A. Some authors, like Le louarn C., have developed surgery techniques to correct those types IV of marionette folds. In this article, we describe the DAO section technique we use. Intervention occurs under local anaesthesia, by intrabuccal approach. Horizontal mucosal incision is performed 1cm long, at the vestibular projection of DAO insertion. Orbicularis oris and buccinator muscles are retracted horizontally to let appear the DAO fibers, which are cut until subdermal fat is seen. This technique must be completed by botulinum toxin type A injection in the inferior part of the DAO to avoid muscular regeneration. DAO section is an easy, quick and efficient surgery, which allows perennial correction in marionette folds treatment. It completes other less invasive techniques to enlarge therapeutic possibilities available for surgeons and patients.

A dermatologic evaluation of the tolerance and efficacy of a topical antioxidant composition in reducing signs of facial aging in Brazilian females

A dermatologic evaluation of the tolerance and efficacy of a topical antioxidant composition in reducing signs of facial aging in Brazilian females

Ingestion of BioCell Collagen&amp;reg;, a novel hydrolyzed chicken sternal cartilage extract; enhanced blood microcirculation and reduced facial aging signs

Skin aging and its clinical manifestation is associated with altered molecular metabolism in the extracellular matrix of the dermis. In a pilot open-label study, we investigated the effect of a dietary supplement, BioCell Collagen® (BCC), which contains a naturally occurring matrix of hydrolyzed collagen type II and low-molecular-weight hyaluronic acid and chondroitin sulfate, in 26 healthy females who displayed visible signs of natural and photoaging in the face. Daily supplementation with 1 g of BCC for 12 weeks led to a significant reduction of skin dryness/scaling (76%, P = 0.002) and global lines/wrinkles (13.2%, P = 0.028) as measured by visual/tactile score. Additionally, a significant increase in the content of hemoglobin (17.7%, P = 0.018) and collagen (6.3%, P = 0.002) in the skin dermis was observed after 6 weeks of supplementation. At the end of the study, the increase in hemoglobin remained significant (15%, P = 0.008), while the increase in collagen content was maintained, but the difference from baseline was not significant (3.5%, P = 0.134). This study provides preliminary data suggesting that dietary supplementation with BCC elicits several physiological events which can be harnessed to counteract natural photoaging processes to reduce visible aging signs in the human face. A controlled study is necessary to verify these observations.

The McCollough Facial Rejuvenation System: A Condition-Specific Classification Algorithm

The search for the holy grail in facial rejuvenation is an ongoing quest. Perhaps the reason the "ideal" face-lift has yet to be discovered is a result of three factors. First, the term FACE-LIFT has never been adequately defined. Second, fads and trends play a role in how the operation is taught and performed. Third, surgeons searching for the prototypic technique have not had a way to index the physical signs of facial aging. After 37 years of practicing facial plastic surgery and performing more than 5000 face-lifts, the author determined that replacing chaos with order is long overdue. To achieve this goal, he developed a classification system that is designed to match each potential patient's problems with the most appropriate facial rejuvenation treatment plan and a "language" by which facial rejuvenation surgeons can communicate. Five progressive stages of aging have been identified and matched with recommended courses of face-lifting, blepharoplasty, volume augmentation, and skin resurfacing techniques. Ancillary procedures have also been included when indicated. It is the author's hope that a new classification system will bring order to mounting confusion within the aesthetic surgery professions as well as within the public sector.

Modified Superficial Musculoaponeurotic System Face-Lift: A Review of 327 Consecutive Procedures and a Patient Satisfaction Assessment

A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold. The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire. The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment. The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.

The effects of a daily facial lotion containing vitamins B3 and E and provitamin B5 on the facial skin of Indian women: A randomized, double-blind trial

The B vitamins niacinamide and panthenol have been shown to reduce many signs of skin aging, including hyperpigmentation and redness. To measure the facial skin effects in Indian women of the daily use of a lotion containing niacinamide, panthenol, and tocopherol acetate using quantitative image analysis. Adult women 30-60 years of age with epidermal hyperpigmentation were recruited in Mumbai and randomly assigned to apply a test or control lotion to the face daily for 10 weeks. Effects on skin tone were measured using an image capturing system and associated software. Skin texture was assessed by expert graders. Barrier function was evaluated by transepithelial water loss measurements. Subjects and evaluators were blinded to the product assignment. Of 246 women randomized to treatment, 207 (84%) completed the study. Women who used the test lotion experienced significantly reduced appearance of hyperpigmentation, improved skin tone evenness, appearance of lightening of skin, and positive effects on skin texture. Improvements versus control were seen as early as 6 weeks. The test lotion was well tolerated. The most common adverse event was a transient, mild burning sensation. Daily use of a facial lotion containing niacinamide, panthenol, and tocopheryl acetate improved skin tone and texture and was well tolerated in Indian women with facial signs of aging.