To determine what can be done, it is important to understand the problem. The aging face is comprised of five interacting factors. It is important to understand each of them to know what can be repaired. The factors are: Photo aging, Intrinsic aging, Expression lines, Gravity, and Sleep Lines.

Photo aging is manifested by fine lines and wrinkles over the entire surface of the skin. It also causes unsightly growths, rough spots, skin cancers, enlarged oil glands, enlarged pores, "black heads" brown spots, white spots, blotches, changes in color and texture (the so called age spots), sallow color, broken blood vessels, easy bruising, and loss of elasticity. In general, everything you can think of to make the skin unattractive. Treatment of photo damage is where a well-trained cosmetic dermatologist can really help. In the last few years' considerable research has been done in techniques that can significantly alter the surface of the skin.

Intrinsic aging simply means that the skin begins to wear out. Most of my patients think this is the major factor in their changing appearance. In fact, it plays a minor role. Intrinsic aging includes thinning of the skin and the disappearance of the fat pad below the skin. Loss of bone from the face, especially around the teeth, is also a major factor. Except in cases of premature aging, intrinsic aging becomes apparent at about age 60-70. Dermatological treatments can help thicken the skin.

Expression lines occur when muscles pull on the collagen fibers of the face over a period of time from laughing, crying, frowning, etc. The constant pull in the same direction all the time creates these lines of expression. Treatment for these lines can be accomplished with filling substances, or with Botox, which paralyzes the muscles and stops the pull on the collagen. The new Ultrapulse Laser can be used to alter the vertical wrinkles around the mouth and eyes. While results vary, some spectacular improvement in these lines is possible. The loss of bone in the jaw contributes a lot to the depth of the mouth creases. Treatment for this part of aging is generally surgical. It is this aspect of aging that really benefits from a face lift. Nothing will do as much for what I often refer to as "sag and bag" as a well-done face lift or eye lift. Collagen implants can give some temporary improvement of the lines at the corner of the mouth. Laser resurfacing can tighten the skin and improve some of the sagging.

Sleep lines were described by Sam Stegman a few years ago. Sleep lines are generally on only one side. They occur from placing the head in the same position every night. A crease occurs much as a crease in a napkin in a drawer occurs. This particular manifestation of aging disappears in the morning in teenagers but will persist longer and longer as we age. Many people in their forties and fifties maintain the sleep crease throughout the day. Definitive treatment consists of attempting to change the sleep pattern, but this is often more difficult that it sounds.