What changes in the face with age
Confusing the layers is the most common reason a treatment does not deliver what was expected: the skin is treated when the support is what has failed, or volume is added when the tissues have descended.
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Layer: Skin
- What happens over the years
- It loses elasticity and thickness; fine wrinkles, changes in texture and sun damage spots appear.
- What responds
- Surface treatments and sun protection. Surgery does not improve skin quality.
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Layer: Fat and volume
- What happens over the years
- The fat compartments are reabsorbed in the upper face and descend in the lower face: the face looks hollow above and heavier below.
- What responds
- Lipofilling (fat grafting) or fillers, depending on the case.
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Layer: Muscular support (SMAS)
- What happens over the years
- It slackens: the nasolabial fold deepens, the jawline drops and the angle of the neck is lost.
- What responds
- Only surgery repositions it.
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Layer: Bone
- What happens over the years
- The skeleton is reabsorbed, above all at the rim of the eye socket, the upper jaw and the lower jaw, and whatever rests on it shifts.
- What responds
- Restoring support without surgery with bioosteoplasty.
A guide only. The assessment examines each layer separately.
What the SMAS is and why it matters so much in a facelift is explained in what is the SMAS.
With or without surgery
The useful question is which of the two fits what is happening to that particular face.
When a non-surgical treatment is enough
When the main change is in skin quality or loss of volume and the support still works. This is the case of someone who notices that their face has lost definition but sees no sagging. Here an approach such as facial bioosteoplasty restores support without an operating theatre or time off work.
When surgery is the option that makes sense
When the tissues have descended. A layer that has dropped has to be put back in place, and that cannot be achieved by adding volume from the outside. Insisting on fillers over established laxity gives a heavier, wider face. In that situation the patient should be told that the non-surgical treatment will not solve the reason for the consultation, even if it is the one they prefer.
Procedures that are combined
Facial rejuvenation is an umbrella term. In practice, a combination of these is chosen:
- 01 Deep plane facelift Repositions the support of the midface, the lower face and the neck.
- 02 Blepharoplasty When excess skin or bags in the eyelids dominate the expression.
- 03 Brow lift When the drop of the tail of the brow is what makes the eyes look tired.
- 04 Neck lift For the neck angle, platysmal bands and double chin.
- 05 Lip lift When a lengthened upper lip marks the lower third of the face.
- 06 Facial bioosteoplasty To restore bone support without surgery.
Doing everything is rarely indicated. Usually two or three procedures account for most of the change the person is looking for, and the rest does not add enough to justify the added risk.
How the plan is decided at the consultation
The starting point is what exactly the person sees when they look in the mirror. Two patients with the same degree of ageing may come in for very different things, and the plan responds to what bothers each of them.
Each layer is then examined separately, with standardised photography and a physical examination. General health is also assessed, as is smoking, which has a strong effect on healing, and the real recovery time the person has available. Correct surgery at the wrong moment in someone's life is a poor indication.
The conclusion may be that it is not yet time to operate. Bringing forward support surgery when laxity is mild uses up an operation without a proportional change.
What not to expect
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That it stops ageing. It repositions and improves; the process continues.
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That it changes the features or the identity of the face. A result that draws attention is usually a poor result.
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That it improves skin quality if the work is only on the support.
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That it replaces habits: sun and tobacco keep acting.
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That it resolves a discomfort that does not have an aesthetic origin.
Recovery
It depends on what is done. Non-surgical treatments allow a return to activity almost straight away, with variable swelling for a few days. Support surgery requires a period of relative rest, with swelling and bruising in the first weeks and a gradual return to social life.
In every case the result takes months to settle. Scars mature over a year, and how they look in the first months is not how they will look later.
Risks and contraindications
All facial surgery shares risks that should be known before deciding: haematoma, infection, changes in sensation, unfavourable scarring, asymmetry and, in support surgery, the uncommon possibility of affecting branches of the facial nerve.
There are situations in which surgery is not performed: uncontrolled illness, active smoking that the person does not want to stop, anticoagulants that cannot be adjusted, or expectations that surgery cannot meet.
Frequently asked questions
At what age should facial rejuvenation be considered?
There is no set age. What decides is the degree of change in each layer, which varies a great deal between people of the same age. Some people have no surgical indication at fifty and others do at forty-five.
Will people notice that I have had surgery?
They should not. A good result makes the face look rested. An artificial look usually comes from tightening the skin without repositioning the deep layer, or from adding volume where support was missing.
How long does the result last?
Support surgery returns the tissues to an earlier position, and from there ageing continues. Non-surgical treatments last less and need maintenance.
Can I have several procedures in the same operation?
Yes, and it is often the sensible choice: a single anaesthetic and a single post-operative period. The limit is set by the total time in theatre and the patient's health. The combination is decided at the assessment.
Does it improve sun spots and fine wrinkles?
Not directly. These are changes in skin quality, and surgery acts on support and volume. They are treated with surface treatments and constant sun protection.
What if I prefer not to have surgery?
It is a legitimate option and often the right one. Non-surgical approaches improve support and overall appearance, with the limit that they do not reposition descended tissues. The assessment explains where that limit lies in your case.