The truth is, we resemble our mothers as we grow older, but after a certain age, we would rather look like our daughters. Through the years, the triangle of youth morphs into the pyramid of age. What defined our younger face - prominent cheekbones, filled cheeks and firm jawline has been transformed by gravity into something closer to a pyramid. Typically, it had become broader at the base because of the descent of fat and less filled at the temples and the cheeks because of bone resorption, fat loss and slowed rate of collagen formation. And to make it worse, we now sport prominent laugh lines, marionette lines, smoker's lips and wrinkles. It is said that we lose about 1% of collagen, per year after we turn 18; something that could further be accelerated by unhealthy habits and unprotected sun exposure. Production of other skin components like elastin and hyaluronic acid also slows down significantly.
Aging is not skin-deep: what we see on the outside reflects pretty much what is going on underneath so assessment should include all layers from skin to bone. Understanding this helps set realistic expectations. For instance, while microneedling with or without PRP, laser resurfacing and chemical peels promote collagen growth, the volume is not sufficient to diminish significant skin sagging, address bone resorption or replace fat lost on the cheeks, undereyes, temples or chin. Our challenge is to use state-of-the-art aesthetic tools and products to artistically turn back the clock and defy gravity. At the DNA level of the skin, lasers, peels, PRP and medical grade cosmeceuticals work by: introducing exogenous hyaluronic acid, coaxing faster turnover of cells and increasing production of collagen.
Buccal and other significant fat loss on the lips and chin can be restored with immediate results non-surgically by introducing dermal fillers made of hyaluronic. Bone resorption effects are particularly obvious in the undereyes, forehead, and malar area. Your Provider has a whole array of fillers to choose from (Juvederm, Restylane, Sculptra) that differ on density, cross-linking and longevity. Currently, it's no longer a "one-filler-fits-all" procedure. Shaping, contouring, and replacing volume can be done in layers with more natural-looking results that feel as good as it looks. However, not all replacement can lift satisfactorily. For jowls that cause the lower third of the face to look squarish, "suture suspension" using threadlifts can anchor the skin to a more lifted position. The submental fat or annoying double chin can be treated with either fat-dissolving Kybella or fat-freezing CoolSculpting. Note that unlike fillers, these don't bring results on the fly. It would take weeks and repeated treatments but results are permanent. Lately, Botox can also reduce hypertrophied masseters - something that is literally "face-changing" even on younger patients.
All these strategic placement of fillers should be complemented with wrinkle relaxers to smoothen the overlying lines and wrinkles. Studies show that have both fillers and Botox prolong the aesthetic effects. Shortening of the face and widening of the horizontal dimension cannot be completely corrected non-surgically but careful and judicious placement of fillers will yield beautiful results and turn back time by upto a decade (or more).