Facial rejuvenation

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]

Overview
Facial rejuvenation is any cosmetic or medical procedure used to increase or restore the appearance of a younger age to human face. The specific term, however, refers to a set of surgical procedures which try to restore facial geometry and skin appearance which are typical of youth, by using a combination of brow lift, elimination of eye bags, eyelids lift, elimination of senile spots, skin aging, facial sagging and wrinkles by face lift and rhytidectomy and physical or chemical peeling, chin lift (reduction of double chin), restoration of facial hairline, etc. These procedures are usually successful and in some cases achieve striking results.

Other medically effective procedures are:


 * Botox injections
 * DMAE creams
 * Permanent makeup
 * Facial toning
 * Collagen injection

Influence of changes in bone structure
More recent research has pointed out the influence of changes in the facial skeleton with age on the appearance of "oldness", especially in the mid-face area and the lower part of the orbits around the nose. quantitative study with CAT scans of the faces of men and women in several age brackets has revealed that there is an appreciable amount of loss of bone tissue in these regions with age, leading to changes in angles, lengths and volumes, and also decreasing the distance between the eyes. This occurs earlier in women than in man. It has been hypothesised that skin sagging and wrinkles may occur not only because of loss of soft tissue and fat, but also because bone retraction creates an excess of skin which is no longer flexible. Future facial rejuvenation techniques may take into account these findings and restore bone lost by aging processes.

Visual appraisal of facial youthness
Human visual perception is notable to its sensitivity and accuracy in estimating or perceiving age by instant pattern recognition of facial features. Often, human faces with nary a measurable difference in facial geometry and appearance are perceived as having different ages. This mechanism is not yet entirely understood, but they may be related to the subtle changes in facial bone structure related above.

Trends in facial rejuvenation
According to the American Society of Plastic Surgeons, more than 114,000 facelifts and nearly 55,000 forehead lifts were performed in the USA in 2004, the majority on women. A significant upward trend on the number of facial rejuvenation procedures is predicted, due to the following factors:
 * 1) Men have also started to perform these procedures at increasing numbers;
 * 2) Emphasis on image of youthfulness by the mass media and fashion;
 * 3) Increasing numbers of senior people enjoying good health and financial affluence at older ages;
 * 4) Decreasing costs of surgery and other cosmetic procedures, making them affordable to all