Tag Archives: gravity

Softening the Lines

10 Apr

P. is a 50 year old woman who has seen me twice over the past two years. To start, she had deep naso-labial folds that she hated. We first filled them with Juvéderm (which was my product of choice two years ago, but now I like Radiesse better for this area). We then did a little bit of cheek augmentation with a large syringe of Radiesse.

P.’s son is getting married and she wanted a little touch-up before the wedding. This is totally common with treatments (and weddings). Remember, any procedure should be done with plenty of time for healing to occur in regards to bruising or swelling.

Before


After


Again, remember, I’m not a photographer! The goal with P. was to soften the downturn on her mouth, the depth of her chin, and the depth of the NL fold.

Gravity…

As you age gravity causes several changes to occur in your face. The fat pads on which your eyes rest slides out from the socket and begins to bulge. At the same time, fat pockets in the cheeks break down in a known consequential manor. The combination of these two things and the pull of gravity on lax skin deepen the look of the nasolabial folds and add years to the face.

So What did I do?

As I said, P. and I have done a few treatments together before. We did the folds first, to fill the depth caused by lax skin and gravity, and then I did cheek augmentation. As I have become more advanced however, I have changed my practices to moving from the top of the face down (because of gravity) and from the most advanced sign of aging backward. I have found this to be the most effective way to treat aging. In retrospect I would have done the following:

  1. Cheek Augmentation

    By reconstructing the fat in the cheek area by filling it with product, this will decrease the laxity of the skin which forms the NL fold. I know women start pulling up the sides of their cheeks at around 30, wondering what a facelift would look like. Well this isn’t a facelift. It’s a laxity lift. (I made that up). It’s an improvement which will help me use less product in the laso-labial fold area. This means a better result AND less money. J


    **Do you do this in the mirror? As you can see, I don’t have much lax skin… from multiple procedures (cheek aug and ulthera mostly). But uh…. I do have roots. No one’s perfect! 😉

  2. Marionette Lines

    This is one of the most advanced signs of aging (because it’s the precursor to jowls). The marionette line starts from gravity pulling down the corners of your mouth and gravity pulling the fat down from the cheek. It’s just a big ol’ gravity mess! Pulling the needle around the corner of the mouth pulls up the downturn of the mouth.

  3. Naso-labial folds

    While this is the LEAST bad sign of aging, this is usually what women are drawn to fixing first. Depending on your age, and your current amount of fat in your face, and the money your willing to spend to have the best result, are all deciding factors on where to start first. Aging didn’t start overnight, and… to be realistic… one treatment isn’t going to restore the youthfulness to your face. Many women’s biggest fear is looking like a Desperate Housewife (fake and expressionless) but this is not the goal of aesthetic medicine. The goal is to restore and maintain your features.

“Softening P.”: A Maintenance Session

P. still had nice volume in her cheeks, and her N.L. folds still had some nice fill (1 year later). P. just needed a little softening to look her best.

X = needle insertion point

Line = needle direction of needle





  1. Mouth Corners
  2. Marionette Lines
  3. Lip line
  4. Chin Sharpening
  5. Jaw Softening
  6. Nasolabial fold softening

Again the Afters


This round of treatment was to soften and touch up. One large Radiesse syringe was used to treat 6 areas. The result is a softer looking face. There is not a HUGE difference in what P. looks like, but there shouldn’t be. Treating six areas with one syringe will not show a HUGE difference. Six syringes in 6 areas… now that’s a different story. Personally, I will only do ONE syringe at a time. Once you fill one area, you change the skin volume, and laxity changes. If someone tries to sell you six syringes at once, RUN. They are not looking out for your best interest, and you are going to leave the office looking like a different person (or something non-human!).

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Physical Facial Changes That Occur As We Age

24 Oct

Women often ask me to look at their face and tell them what I see as signs of aging.  I love loaded questions!  Many women don’t know what exactly it is that makes them look older, they just know they see age on their faces in the mirror.  Almost 90% of aging is due to sun damage.  So please start wearing sunblock everyday! (It makes a great base for mineral make-up, or if you like make-up free, get a tinted moisturizer with SPF).  Coming blogs will explain what to do about these factors!

These changes are sequential and predictable!

Starting at 25…

Beginning in your mid-twenties, the rate of skin cell renewal actually slows. As this happens, your skin becomes thinner which makes it more prone to damaging environmental elements like the sun, harsh weather conditions, and pollution, which causes it to develop a dull, rough, or uneven texture. In addition, the network of collagen and elastin fibers that is so important to maintaining the skin’s structure and elasticity breaks down and slowly diminishes, resulting in fine lines, wrinkles, and loose, sagging skin. Lastly, lipids that form a barrier against water loss in the stratum corneum break down in response to changing hormone levels. The skin’s moisture barrier becomes leaky, allowing water to escape the skin, which may cause your skin to become drier with age.

When you’re younger you have a triangular shape face, and as you age, it becomes more trapezoidal.

Wrinkles

Wrinkles occur because of the damage the sun inflicts on our skin’s collagen and elastin matrix. The sun breaks down that matrix, leaving skin thinner, saggier, and less able to regain its former, tighter contour.  The skin falls into the crevice of muscle fibers which forms the wrinkle.  Muscle movement does not cause wrinkles, but it does contribute to forming them. 

Nasolabial Folds

Gravity pulls the skin and causes it to sag, creating folds in the face.  First they increase in prominence, then they become deeper.  If you look at your face in the mirror you will see one side has deeper folds than the other.  This is from the gravity that occurs as we sleep.  Because most of us are side sleepers, the deeper side is the one that is opposite the side we sleep on.  Look in the mirror.  Is this true for you?

Mouth Area

The cupid’s bow becomes less defined as the upper lip flattens and lengthens.  The lips become thinner, and the corners start to turn down, making the appearance of a permanent scowl.  This scowl continues to increase in recognizably as marionette (puppet) lines form and a pre-jowl depression becomes more prominent.  Vertical lines begin to form (called rhytids) around the mouth.

Cheek Volume

One sign of aging that women often don’t notice is the loss of volume in their cheeks.  We loose fat in our face (and I think it travels to other fun places).  This also contributes to making naso-labial folds look deeper.  Check out Cheek Augmentation with Radiesse: A Personal Experience.

Eye Area

Gravity.  Fat pads from gravity slide out from the eye area and begin to bulge the skin beneath the eye.  The skin above the eye begins to sag and cover the top lid.

Age Spots

Also known as hyper-pigmentation or photoaging, is caused by over production of melanin in the skin.  This is from sun damaging your cell’s DNA.

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