Facial wrinkle
Aging face
Although it is inevitable for one to get old, however it is also a kind of unwanted thing. Aging makes alterations of whole body. In case of face, facial drooping with skinny depression is the distinct feature. This characteristic feature is due to the following causes.
- Degeneration of elastic and collagen fiber of dermal layer results in the decrease in the resilience.
- Weakness of the structures supporting the skin and soft tissue causes drooping of the whole face.
- Sagging of the upper eyelid and eyebrow makes tired-looking appearance.
- Depressed periorbital and cheek make sunken and skinny appearance.
- Cheek drooping and perinasal wrinkle gets prominent and nasolabial fold grows deepened.
- Periorbital fat of the lower eyelid is protruded and looks bulged.
- Deepened wrinkle and crow's feet occur.
- Fat is accumulated under the jaw and this usually accompanies the sagging neck which is also called 'turkey neck'.
Senescent change of face can make one feel depressed. Rhytidectomy can partially reverse and decrease the senile changes so that one can overcome the shrunken self-esteem.
There are several types of rhytidectomy including classical facelift with forehead and browlift, platysmaplasty, blepharoplasty, endotine lift, botox and a few filler matrials. Chemical and laser peeling can be classified as the rhytidectomy in a broad sense.
Indications
Almost all people having prominent wrinkle can be the candidate. However, patients who keep some degree of elasticity on their face can have superior outcome. Most of the patients are from 40 to 60 of age, though 70 to 80 year age patient who are still healthy can have benefit from the surgery.
Facelift with skin excision
The classical and conventional surgical method is the facelift with skin excision. This comprises the incision and excision of the redundant skin. If the severe sagging is the main problem and other method seems ineffective, facelife with skin excision is still the recommended surgical treatment. Blepharoplasty, liposuction, and platysmaplasty can be planned simultaneously.
Incision starts from the hairline and continues to the preauricular and postauricular area. After the dissection under the skin, subcutaneous fatty layer and muscle with fascia are pulled tightly and fixed. Skin excision ensues. Clipping of the scalp follows the skin closure.
Drains are inserted under the skin for the prevention of the hematoma then the compressive dressing is performed. This surgical procedure needs several days of hospitalization and a few hours of operation time under the general anesthesia. Drains are removed within 1 to 2 days and dressing can be gotten rid of in 5 days. Temporary swelling and bruise on the face may last for more than a few days after the removal of the dressing.
Most of the stitches can be removed within 5 to 7 days and clip of the scalp should be remained for a few more days. Head elevation is recommended for several days postoperatively. One can go outside in postoperative 1 week and go back to daily life and social activity in 2 to 3 weeks postoperatively.
Initially, patient may not be satisfied with the surgical outcome due to the remaining swelling of the face. However as it goes, most of the patient are pleased with the result. Temporary bruise and swelling are restored in a few weeks. Some degree of paresthesia is common and can be recovered in a few months.
Forehead/Brow lift
Rhytids in the forehead is attributed to the contraction and relaxation of the thin and wide frontalis muscle. As the eyelid droops, unconscious forced elevation of eyebrow with forehead ensues repeatedly and wrinkles on the forehead get deepened. In this case, forehead lift other than botox or filler material is the most effective treatment modality.
Excision of scalp above the hairline and pulling up the skin are the main procedures. Temporary heaving of the eyelid and tightness of the skin can be felt. However, these symptoms are resolved spontaneously in 1 to 2 weeks. With selected cases, endoscopic approach can be tried and may give shorter incision line.
Among these surgical techniques, the patient is strongly recommended to be offered sufficient explanation and advice from the plastic surgeon's professional point of view.
Alar flaring
Skin of neck is thin and easily dried and repeated flexion and extension provide early senescence. Horizontal rhytid of neck begins around late 20??s when the loss of skin tension occurs. Vertical wrinkle of neck is caused by the wide and thin platysma muscle in prominent two lines. Platysmaplasty can be made simultaneously with the face lift. If the platysmaplasty is planned independently, submental incision below the jaw is preferred and fatty sagging can be removed at the same time.
Upper & Lower blepharoplasty
See "Blepharoplasty" section
Endotine lift
Recently the bioabsorbable implant called 'Endotine' can be considered for the various face lift procedures. The word 'Endotine' is a compound word composed of 'endo' which means something inside and 'tine' that implies claw. It is made from the bioabsorbable material that is hard like plastic initially and is gradually absorbed to be melted away. Via two tiny 1cm sized incisions, forehead and eyebrow are lifeted upward and fixed in the small holes on the scalp for the tines of endotine. Lifted skin is conglutinated with the bone then the endotine is absorbed. Compared with the conventional facelift, operationg time and convalescent period are shortened, complications are decreased as well.
Endotine can be also applied on the midface via the subciliary, temporal, and intraoral incisions.
Microfat graft
Nowadays, it is widely accepted that senile change of face is caused by the drooping of the facial skin as well as the atrophy of the supporting structures. Devoid of feeling of fulfillment maintained by the protein and hyaluronic acid, forehead and eyebrow look sagged. Periorbital and malar area go gaunt and one look tired and old. Fatty drooping of jaw and eyelid grows prominent and nasolabial fold gets deepened.
Replenishment of the volume through microfat graft can restore the youthful look and weaken the rhytid secondarily. Fat can be harvested from the abdomen, thihg, and buttock with fine aspiration cannula. Then aspirated fat is purified with centrifuge.
This purified fat is injected in the wanted site. Smoking and strenuous exercise should be avoided for 2 to 3 weeks as the neovascularization occurs and fat is taken to the recipient site during this period. Microfat graft includes the extraction of a small quantity of fat and has little risk during the whole procedure. However, it is not uncommon that partial absorption occurs so that the overcorrection and reinjection would be needed. Inflammation and infection result in the dissolution of the grafted fat. For the precaution, appropriate usage of antibiotic is indicated and aseptic technique is applied.
Botox / Filler
Botox and filler can be effective on improving the rhytid without invasional procedure. However, its effect may be limited according to the site and degree of the rhytid so that it would be wrong one can get rid of the wrinkles without surgery.
Botox
Botox is originated from the botulinum toxin that causes food poisoning from the canned goods. Botulinum toxin decreases the secretion of the acetylcholine and results in the prohibition of muscle contraction and prevents the skin from wrinkled. Because the rhytid is formed from the longstanding muscle contraction, suppression of the muscle activity can contribute to weakening of the facial wrinkle. However, overdose injection can cause undesired muscle palsy and eventually the drooping of the muscle and lethargic facial expression. Therefore it is important for the patient to be consulted to the specialist and have an adequate dose of injection. The whole procedure takes about 10 minutes. Effect begins in 2 to 3 days and unfolded rhytid is evident in 1 to 2 weeks after the injection. However, new nerve terminal sprouts again in 4 to 6 months and the effect of botox disappears. Therefore, repeated injection of botux is necessary. Wrinkles in the glabella, rhytids from the wearing a smile in their eyes, shallow forehead wrinkles can be good candidates for the botux injection. But its effect is limited in case of deeply formed wrinkles.
Chemical peeling and laser
Chemical peeling and laser can act directly on the rhytid and its surrounding skin tissue and have an effect of improving the wrinkles. Various chemical materials can be applied with different concentration, therefore the safety is guaranteed only with the specialists. Peeling deep into the dermis can cause new scar, accurate and precise management is mandatory for the safe procedure. In addition, temporary erythema can be accompanied not infrequently and photosensitivity to the Ultrviolet light, ointment relieving the erythema and sunscreen blocking the UV should be used and precautions should be well acknowledged.
Filler
Increasing the volume of the crease of the facial wrinkle can be obtained with various materials and its effect and durability are different from each other. This is simple and has immediate impact, but some material hostile to the human physiology i/e paraffin can cause skin necrosis even into the skin cancer. For the affinity to the human nature, autologous fat is available and hyaluronic acid (Leviderm, Rofillan, Restylene, Radiesse), Collagen (Artecol), Allofascia (Fascian) can also be considered. As each material has its own characteristic property, it is highly recommended that material adequate to the patient should be used. Nowadays, cream (potox) is introduced, which prohibit the production of special complex stimulating the secretion of the acetylcholine, ketacholamine related with the muscle contraction resulting in the gradual decrease of the muscle contraction. It consist of Argireline, Magnesium ascorbyl (collagen builder), Hyaluronate, Shea butter and argireline (non-toxic-anti-aging peptide) play major role in reducing the neurotransmitters.This is similar with the effect of botulinum toxin, cream type is convenient for use, continuous effect can be expected during the application. It has relatively weak effect than the botulinum toxin. Therefore concomitant usage with the botulinum toxin can make synergistic effect. Recent clinical study shows that it shows delayed effect after 2 months of application despite of the individual variations. Like these treatment modalities, for the improvement of the facial wrinkles, one must consult to the specialist and take adequate treatment modality so that they can get predictable and satisfying result.
Prevention of facial wrinkle
- Moisturize skin
- Persons who haved oily skin tend to be reluctant to rub the moisturizing cream, however, periorbital area and neck where are easily dried should be moisturized with moistening product.
- Avoid UV light
- Use the sunscreen so that can block the UV light which is the main cause of senile change of skin and fine facial wrinkles.
- Take sufficient water
- Take vegetables and fruits.
- Keep regular pattern of lifestyle and sound sleep
Wrong lifestyle that can cause the facial wrinkles
- Avoid smoking
- Avoid severe weight reduction
- Check the wrong habbit of facial expression.
- Check the position in sleeping
- Use the adequate height of pillow and sleep with right body position.
