Correction of the contours of an aged face: cheekbones, chin, nose

Contour correction of age-related changes in the bone base of the skull is one of the most complex but effective methods of facial rejuvenation. In patients with congenital weak skeletal structure, excessive resorption of bone and cartilage tissue may be a major cause of premature aging. Areas with a more pronounced tendency to bone resorption are the temporal regions and the mandible, in particular the angles of the mandible.

Certain changes occur in all tissues of a woman’s body over time: bones undergo resorption, muscles undergo atony, subcutaneous fat tissue undergoes atrophy or hypertrophy, migration of fat packets is observed, and skin tone and elasticity decreases.

Depending on age, type of aging and individual characteristics, the oval of the face (upper and lower contour) also changes.

Among the structural changes in the lower contour are:

• atrophy of the alveolar processes;
• chin protrusion;
• downward migration of local fat;
• the appearance of wrinkles and furrows (“marionette lines”);
• ptosis.

This is manifested by drooping tissue (“bulldog cheeks”), sagging, wrinkling, excess fat deposits in the lower part of the face (double chin), deepening of the nasolabial fold, wrinkles in the corners of the mouth.

Structural changes in the upper contour:

• bone/cartilage resorption, decrease in skull thickness;
• deepening of the temporal fossa;
• depression of the eyebrow line;
• expression of wrinkles.

Visual manifestations of aging in the upper third of the face are drooping of the upper eyelid and lateral areas of the eyebrows, deepening of wrinkles in the forehead and bridge of the nose, and a more gloomy appearance.

The importance of holistic care

To correct these changes, an integrated approach to rejuvenation is required, slowing down skin aging by stimulating collagen production, improving microcirculation, reducing fat deposits, providing antioxidant and restorative effects, and effectively improving metabolic processes.

The main principles of correction will be:

• increased tone and elasticity;
• improvement of microcirculation and lymphatic drainage;
• elimination of local lipodystrophy;
• creating a frame and tension lines;
• eliminating facial stress on individual zones;
• replenishment of soft tissue volume (contour and volumetric correction).

It is necessary to adhere to an approximate plan and order of correction: first, stimulating procedures that improve the qualitative characteristics of the skin, and then fixing and consolidating the result, affecting the quantitative characteristics.

If you use only one of the methods, the result will not be positive and lasting, and therefore will not satisfy the requirements of patients.

Problems that need to be solved when correcting an oval:

• top: “open the eyes”, raise the eyebrows, fill in the temporal pits, correct wrinkles in the forehead and bridge of the nose;
• bottom: remove excess fat, fill “marionette lines”, emphasize the angles of the lower jaw and straighten its line, correct the projection of the chin.

Possible options for improving metabolism and microcirculation in the skin, that is, quality indicators, must be divided into groups depending on the main operating factor. In particular, among them:

• hardware (microcurrent, vacuum, ultrasound, Darsonval, fractional photothermolysis);
• non-hardware (basic care, massage, cryotherapy);
• invasive (mesotherapy, plasma lifting, mesothreads);
• non-invasive (peelings).

Injection methods for correcting facial contours.

Biorevitalization : this is a proven, effective correction method. With intradermal administration of hyaluronic acid (HA), stimulation of the dermal matrix, synthesis of endogenous HA, neocollagenogenesis, neoangiogenesis, replenishment of skin hydration, and a powerful antioxidant effect occur.
For the procedure, HA can be used, unstabilized or partially stabilized, high-molecular pure or in combination with mannitol, glycerol, and vitamins. Being a polyanion in structure, hyaluronic acid is capable of binding and retaining large amounts of water due to hydrogen bonds.

To restore the structure of the matrix, the optimal ratio of molecular weight (2−3 million Da) and concentration is critical. The combination of concentrations of 15 mg/ml and higher forms a molecular network that creates a reserve of HA in the extracellular matrix and stimulates intracellular synthesis.

When performing biorevitalization in the area of the lower third of the face, along with the papular technique, the superficial linear technique (controlled intradermal destruction) and the lattice technique are often used. Areas of depression and wrinkles and the parotid fold are especially actively treated.

As a result of the correction course in these areas, the following are visually determined:

• pronounced lifting effect;
• tightening and filling the skin;
• reduction of fine wrinkling and depth of folds;
• even out skin color;
• smoothing the relief.

Mesotherapy : cocktails for correcting the lower third of the face use lipolytics, vitamins and microelements, nucleic acids and amino acids, antioxidants, biostimulins and growth factors, hyaluronic acid.

Anti-age mesotherapy uses active regenerating and stimulating cocktails that improve the quality of the skin. The synthetic and proliferative work of fibroblasts is stimulated, the number of collagen and elastin fibers and matrix increases, microcirculation improves, and oxidative stress is eliminated. Preference is given to cocktails with growth factors (EGF, IGF-1, bFGF, VEGF) and biostimulins.
The drugs are administered using the nappage technique, papularly and linearly. The course consists of 6-10 procedures, carried out once a week or according to the scheme.

In the lower third, not only the usual tightening cocktails are used, but also lipolytic cocktails: silicon 0.5% + hophytol + procaine, L-carnitine + caffeine, phosphatidylcholine + deoxycholinic acid. These are ready-made cocktails for the treatment of local lipodystrophy (Mesoline, Inno-TDS, mesoEXPERT). At the same time, so that the solution gets directly into the hypodermis, the skin is folded. Depending on the cocktail, 6-8 procedures are required, carried out every 7-10 days, or 2-4 procedures every 10-14 days.

A mesoscooter can be used as a device for administering mesotherapy drugs. When rolling the mesoscooter, microholes are formed in the skin, which ensure uniform depth and uniform penetration of drugs. They combine the stimulating effect of the mesoscooter itself and medications. Depending on the indications for anti-age therapy, different lengths of mesoscooter needles are used (1−2 mm), the procedure is carried out once every 3−4 weeks.

Mesothreads : since the skin, when introducing threads, reacts to them as a foreign body, this is accompanied by increased cellular and vascular proliferation in the places where they are placed, neocollagenogenesis.

Combination of mesothreads and plasma lifting : two effective procedures that potentiate each other’s action. PDGF (platelet-derived growth factor) initiates the healing of connective tissue, the formation of a collagen matrix, accelerates mitogenesis, angiogenesis, macrophage activation, and the secretion of growth factors. The targets are fibroblasts, muscle fibers, chondrocytes, osteoblasts, and mesenchymal stem cells. Two procedures are performed in one session. First, blood is drawn from a vein. While the blood is centrifuged, mesothreads are introduced. When they are installed, before removing the guide needle from the tissue, 0.02 ml of the drug is injected into it with a syringe.

Autoplasma (PRP) with platelet-derived growth factor (as a single procedure) is injected deep into the tissue and superficially papularly. Course – 4-6 procedures, once every 2-3 weeks.

Botulinum toxin injections : first of all, it is worth following the sequence of procedures: mesotherapy - botulinum therapy. Why? First, it is necessary to improve the quality of the skin, start the work of fibroblasts, increase the amount of matrix with the help of hyaluronic acid, and strengthen the vascular wall. Then you need to consolidate the result and reduce facial stress on problem areas. Mesotherapy refers to actively stimulating procedures; accordingly, the effect of botulinum toxin (if it is performed before mesotherapy) will pass faster. This is due to the fact that a new branch of the nerve innervating the “blocked” muscle will grow faster. Consequently, the muscle will begin to contract again and wrinkles will appear.

As a rule, Botox injection is practiced for correction in the upper part of the face: in the forehead, bridge of the nose, eyes. When working with the lower third, botulinum toxin injections are used to block the depressor anguli oris muscle to correct “sorrow lines”, as well as the subcutaneous muscle of the neck. In this area, above and below the lower jaw bone, botulinum toxin injections are made using the papular technique in double dilution. As a result, we get a clearer oval - “Nefertiti oval”.

Fillers : Most often, patients seek correction of nasolabial folds, “purse-string” wrinkles around the mouth and “sorrow lines” in the corners of the mouth. Preference is given to natural biodegradable fillers based on hyaluronic acid. The duration of the effect of Teosyal Ultra Deep, Pluryal Volume lasts from a year to two, depending on the area of administration, the amount of the drug, lifestyle, water and drinking regimen.

Why doesn't the effect last forever? First, the enzyme hyaluronidase “processes” and breaks down HA as if it were its own. Secondly, the face changes with age, so correction of aesthetic defects must be carried out after a certain period of time and each time in a new way. In this case, it is necessary to explain to patients that the result does not appear immediately, but gradually.
The introduction of fillers into the parotid fold creates a filling and tensioning effect. In this zone, by the age of 30–35, a fold forms, and by the age of 40, several folds or a network of wrinkles. The correction is as natural as possible and gives a slight lifting effect. There is practically no overcorrection, since the drug fits directly into the fold.

In areas of depression, a lattice frame is formed with a needle or cannula (0.5−1.0 preparations on each side). It is preferable to work with a cannula, since this method is less traumatic and more “wide-scale”.

Having analyzed the places where fillers are injected, we can conclude that their quantity is much less important compared to the correctly chosen place. The correct insertion points are where the distance from the skull bones to the skin is shortest and the soft tissue is thinnest. This applies primarily to the temporal region and lower jaw.

Taking into account the morphotype

Also, to adequately correct age-related changes in facial oval, it is necessary to take into account the patient’s aging morphotype.

"Tired" morphotype

The “tired” morphotype is considered the most favorable option, a kind of marker of the physiological course of aging. This option is typical for thin women with an oval or diamond-shaped face.

Skin characteristics: the skin is initially normal or prone to dryness, subcutaneous fat is moderately developed, there is an infraorbital and/or nasozygomatic (cheek-zygomatic) groove, moderate ptosis of the lower third of the face, nasolabial folds and “marionette lines” of medium depth are observed. Muscle tone and skin turgor are reduced. Ptosis and deformational changes are not pronounced, manifestations of skin photoaging are moderate.

These changes give the face a tired, tired appearance, which is most noticeable in the evening.

In aesthetic correction, it is recommended to use basic care with modeling, collagen, thermoactive masks, cryotherapy, vacuum roller massage, microcurrents. This type “responds” well to mechanical stimulation - microdermabrasion, mesoscooters. Mesotherapy is performed with vitamin antioxidant cocktails, biorevitalization with boosters. Glycolic peels up to 70%, TCA 15−20%, fractional photothermolysis are recommended. An effective correction method for this morphotype is mesothreads. Correction with botulinum toxin and HA fillers is also effective in most cases.

Finely wrinkled morphotype

Women with a finely wrinkled morphotype have an oval face in youth; with age, this shape remains, less often it approaches rectangular. Among them, asthenics predominate, who do not have a tendency to be overweight.

Skin characteristics: thin, sensitive, often dry, subcutaneous fat is poorly expressed, a large number of wrinkles - from small to deep, moderate ptosis of the lower third of the face is noted. Muscle tone is slightly reduced, therefore the sagging of the soft tissues of the face is insignificant.

The finely wrinkled type closely correlates with the manifestations of skin photoaging.
Basic care is dominated by moisturizing, nourishing and brightening programs. Iontophoresis, phonophoresis with moisturizing and stimulating serums, microcurrents, gentle combined peelings (with glycolic acid up to 30%, salicylic acid - 2−5%, lactic acid, kojic acid, phytic acid, with resorcinol), hydrodermabrasion, fractional photothermolysis are recommended. Mesotherapy with active regenerating and stimulating cocktails with growth factors, biorevitalization, and plasma lifting are used. Adequate correction with botulinum toxin and HA-based fillers is always effective.

Deformation morphotype

The deformational type of aging is characterized by a predominance of swelling of the facial tissues, symptoms of lymphostasis, and severe sagging, especially in the lower third of the face.

Along with this, wrinkling and pigmentation disorders are not typical, the skin is quite dense, shiny, sometimes porous, and the facial features are large. A pronounced reaction of the skin in response to damage, which is manifested by a tendency to swelling and inflammation.

Severe deformation of the lower third of the face, nasolabial folds can eventually merge with “marionette lines,” and a double chin is often present.

Some women may have pronounced redness of the cheeks due to persistently dilated small vessels (rosacea), and telangiectasia can often be found.
This morphotype of aging usually manifests itself in women with a dense build and a tendency to be overweight. Excessive subcutaneous fat layer on the face leads to severe deformation of facial contours, with the formation of a double chin, “jowls,” folds on the neck, bags under the eyes and drooping upper eyelids.

Basic care necessarily includes lymphatic drainage massages, contrast compresses, cryotherapy, microcurrents, vacuum roller stimulation (provided there is no rosacea). Peels – combined superficial-medium and median. Mesotherapy: in the lower third, not only the usual tightening, but also lipolytic cocktails are used: silicon 0.5% + hophytol + procaine, L-carnitine + procaine, phosphatidylcholine + deoxycholinic acid, ready-made cocktails for the treatment of local lipodystrophy (Mesoline). In this case, the skin is folded so that the solution gets directly into the hypodermis. Mesothreads are used to create a frame support mesh. Correction with botulinum toxin is contraindicated or ineffective in most cases. Correction with HA fillers often requires a larger amount of the drug.

Muscular morphotype

The muscular type is not typical for the Slavs. As a rule, representatives of the yellow race grow old in this way. It is predominantly characterized by pigmentation disorders, folding of the eyelids, pronounced nasolabial folds, and “marionette lines.” At the same time, the skin of the cheeks remains even and smooth, and the oval of the face is preserved until old age. This is due to the fact that muscular individuals have well-developed facial muscles, as well as a genetically small amount of subcutaneous fat.

In women over 55 years of age, these morphotypes of aging are mixed, and, as a rule, we can already talk about a combined type (late type of aging) with a predominance of one or another type of aging.

Thus, with regular care and adequate correction, age-related changes can be eliminated, youth, freshness and good mood can be prolonged.

This article is part of the special project Injection anti-aging

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