Aging takes place throughout the body but the most prominent signs of aging are seen in the skin. Sagging and wrinkles that form in the face are of particular concern. Especially the wrinkles around the eyes are the most visible. In this article, we will discuss what causes aging and how we can treat or prevent the signs of aging.

Generally, wrinkles are thought to be cause by three major factors.

1. Gravitational pull: Wrinkles form as the skin is pulled downward by gravity. The direction of wrinkles are determined by the position of ligaments between the skin and bone.

2. Muscle movement: Vertical wrinkles form where the skin is pushed together.

3. Repeated sun exposure: The sun rays accelerate age-related sebum reduction and degradation of collagen and elastic fibers.

Age related changes in fat distribution and bone density also contribute to visible signs of aging. For example, fat can accumulate in the lower chin and cause a double chin and winkles. Nasolabial lines and jowls are also caused by gravity or muscle movement but have recently been found to be also affected by changes in fat distribution.

Sagging can be corrected by lifting the tissues in the opposite direction from the pull of gravity. Wrinkles that are caused by muscle movement can be corrected by botulinum toxin or dermal fillers. Aging signs due to fat accumulation or atrophy can be corrected by liposuction or fat graft. One should remember that there are various factors that simultaneously affect the aging process. It is important to address the most prominent cause but combining other treatments for addressing other factors can bring better outcomes.

Sagging of the facial skin does not occur in the vertical direction, but rather in cascades much like the Roman shades. This is because the retaining ligaments that connect the skin to the bone hold the skin in different places (Image 1). The ligament works like the string of a curtain that pulls back certain sections of it. This can be seen in the jawline. The skin in this area does not sag uniformly. There is a rounded sagging up to the mandibular ligament that connects the skin to the bone near the chin. That is how jowls or marionette lines are formed.

 

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Image 1. (left) In Roman shades, the rods in the middle hold the curtain and create a division. As shown in Image 2, the face is divided into two sides; young and aged. The right side has a sagged jowl along the jawline due to the ligament that holds up the skin.

 

-To be continued-