22 Jun Beauty to the Bone.
BY Dr Terrence Scamp
They say that beauty is only skin deep but in fact the bone structure of your face has an enormous impact on your appearance and also on the way you age.
When you see the tall slender supermodels with their long necks and strong jaw lines, you can rest assured that the tremendous support that sort of bone structure gives to the skeleton means that they are likely to maintain good neck contour well past the age when many of us might have a spare chin or two. Sure they may age their skin and get wrinkles and lines, particularly if they have too much sun or smoke, but that great bone structure helps to hold the soft tissues in the right position and resists the effects of gravity.
The obverse also applies. If the jaw is small and the chin somewhat recessive then at an early age you will see a blunting of the angle where the neck joins the jaw line and the clear definition of the jaw starts to blur into the upper neck.
People with small chins often present seeking removal of some fat from below this area. If they are young and their skin tone is good often liposuction to this area beneath the chin is sufficient. However for most people over 40 laxity of the skin and the muscle there accompanies this and in addition to the fat removal redraping of the soft tissues is required. In most people this means a face and neck lift.
The modern face lift has graduation from being a simple tug on the skin as was common 40 years ago and is perpetuated in the modern myth of the “S” lift, to a far more sophisticated multidimensional procedure.
The problem with skin is it’s designed to stretch. Placing tension on the skin to smooth the face can only be of short term benefit as the skin will “give” and the tissue laxity will return.
The modern face lift transfers the power of the lift into the deeper tissues, the platysma-SMAS layer. This layer comprises a thin muscle sheet and fascia that has far greater intrinsic strength than the skin. When these tissues are mobilized and supported correctly restoration to the contour of the neck is seen and the jowl is lifted. The skin of the face and neck can then simply be redraped in its new elevated position with minimal tension.
The lack of tension on the scars provides better circumstances for healing and finer scars usually result. Also because the tension is not transferred directly to the skin the face tends to look more natural and refreshed rather than tight and stretched. The greater strength of these deeper tissues also adds to the longevity of the result.
Where the bony contour of the jaw is seriously deficient further intervention may need to be considered. This may range from enlarging the jaw line either with a silastic prosthesis or with fat grafts or actually advancing the jaw bone itself.
Because the face does more than just sag as it ages, facial rejuvenation has expanded to include a number of other modalities. Apart from the sag, the aging face will also shrink. The full round tissues of youth give way to the hollowness of the aging eye region and the emptiness of the aged cheek. Lips lose their fullness and their bloom and the lines near the mouth become deeply entrenched.
For this reason a modern facial rejuvenation will commonly address the loss of volume in the face. This can be improved non-surgically by use of injectable materials. These materials allow Plastic Surgeons to enhance lips, fill lines and restore a youthful cheek and jaw shape without picking up a knife. Longevity with these products is often in excess of twelve months and they have a remarkable safety record.
Where face lifting has been undertaken it is possible at the same time to produce a more permanent correction for the loss of facial volume associated with aging. Fat is commonly harvested by means of a needle from the abdomen and injected around the eyes, into the cheeks, into the deeper creases at the sides of the mouth and into the lips themselves and the jaw line. Fat grafting is a bit more unpredictable than soft tissue injections. The fat has to regain a blood supply and survive to maintain its size. Usually by three months it is clear how much of the fat has survived and the procedure can always be repeated. Conversely a little top up with some of the above products can just add to the final result without resorting to further surgery.
So beauty is more than skin deep these days. The modern Plastic Surgeon is thinking from the bone up and looking for a natural, refreshed, healthy shape to the face that keeps you guessing about their age.