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The secrets of facial aging

After nearly a century's worth of development and dedication to the field of aesthetic medicine, we can say we have a good idea about how the face ages, correct?

Dr. Lambros“Not true,” says Newport Beach, Calif., plastic surgeon Val Lambros, M.D. “There is no science, and people have no concept about how the face ages, and they will find justification in whatever procedures they like to do.”

Dr. Lambros presented “Unraveling the secrets of facial aging” at the American Society for Aesthetic Plastic Surgery’s The Aesthetic Meeting 2017 in San Diego, Calif.

For more than a decade, Dr. Lambros has collected and studied 3-dimensional facial images to better understand facial aging’s progression using a 3-dimensional camera system (Vectra, Canfield Scientific) to create facial aging progression averages. Dr. Lambros and coauthor Gideon Amos, PhD, an employee of Canfield Scientific and developer of the software, published a paper on the topic December 2016 in Plastic and Reconstructive Surgery.

Through animations of facial aging progressions, they found obvious changes, including the lid aperture becoming vertically and transversely smaller. The average lower lid, according to the paper, doesn’t fall with age; rather, it rises. There is a strong and common tendency for posterior movement of the columellar base. And, as lips thin, alar bases splay and elevate and the nasal tip droops. In essence, the entire lip appears to thin and move posteriorly, taking the nasal base along for the aging progression.

“Surgeons operate and think that the face ages by falling down, and [surgeons] pick it up,” Dr. Lambros says.

Dermatologists [and other cosmetic doctors] armed with fillers say that the face deflates and needs filling to be more youthful, he says.

While there is some truth in all of this thinking, what’s lacking is a more complete understanding of how the face actually ages, he says.

“Meetings should be about more than tips about how to do things. They should be to discuss basic precepts and truths about the face and body and move from that to therapy. If you didn't know how a watch worked, I wouldn't be confident in letting you try to fix it,” Dr. Lambros says.

Disclosure: Dr. Lambros reports no relevant disclosures.

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