Tag Archives: volume loss

Peanut Head: Volume Loss at the Temples

29 Jul

I’d argue the most over looked sign of aging is loss of volume in the temple. As we age, the temples lose fat and begin to narrow, shifting the balance of the face downward. Volume loss here contributes to the appearance of drooping and sagging of the cheeks and eyes (see Structural Changes in the Aging Face for other changes).  It begins as early as in your 20’s. It is most notable in athletes who have very little fat on their bodies, I’ve found especially runners.

As you can see, the area of total volume loss is pretty big when you actually look at it. In order to achieve the youthful contour of the temple, a patient will require a lot of product here. Adding filler to the temple is easy and almost painless, but deciding what filler to use can be difficult, they all have pro’s and con’s.

Juvéderm

This is usually my first choice with patients. For some reason… people tend to be nervous about filling this area! The great thing about Juvéderm is that it’s disolvable. The bad thing about Juvéderm is… you need a lot of it to fill this area, and that can be expensive. I’ve found great results by diluting the product before injection. The patient can see the result immediately. It may not last as long this way, but it is a good starting point. Most people love the result and usually step up to Sculptra when they notice they need a “refill.”


Radiesse

I personally don’t use Radiesse in the temples. It always reminds me of the scene from the Real Housewives of Beverly Hills when Adrienne Malouff’s husband injects Taylor and she has this big bump in her temple and Adrienne goes “is it supposed to look like that?” Although you get more volume with Radiesse, you also have more of a chance for lumps in this area. It’s not as smooth as Juvéderm (which is literally defined as a smooth consistency gel). It’s just not my preference, but for extreme volume lost I can see it being more cost effective.


Sculptra

I personally have had Sculptra injected into my temples. Sculptra is not a filler, but a biostimulator. Over several weeks post injection it promotes collagen production. It may take more than one treatment (usually 1-3 vials 1-3 treatments) to achieve the desired result. This is the longest lasting, and most cost effective product if you consider the longevity, but up front can be expensive. If you are the type of patient who is doing multiple fillers at a time, you should probably step up to Sculptra.


Fat Transfer

Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face. I recommend only allowing a plastic surgeon perform this procedure (although a nurse can do it in Massachusetts). The fat is harvested from another area of the body (usually the lower back) via liposuction and transferred to areas of volume loss in the face (usually not just the temple). There is a lot of swelling and bruising with this treatment and not all the fat will graft (stay alive after transfer). It is also an expensive and invasive procedure. This being said, it can yield great results for patients who really need it.


The Procedure

Numbing cream is applied to the temple. The product selected is mixed with lidocaine and deposited on the bone until achieving desired volume. There is very little pain associated with all injectable products. Bruising isn’t typical; however, there are many vessels in this area, so it can happen. Expected cost depends on the product selected, but expect to use at least 1-2 syringes during time of treatment.

Good luck!

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Structural Changes in the Aging Face

3 Jan

Wrinkles and sun spots aren’t the only things we can expect to happen to our face as we age. There are many structural changes going on below the skins surface that contribute to an aging face that most people would never have noticed when they look in the mirror.

The young face on the left is round, contoured at the cheeks, and has a sharp jaw line (oh and hair and no wrinkles). The face on the right appears narrower, sunken, and droopy.

So besides the integrity of your skin, what else has changed?

Below the Skin

Bone Structure

Let’s start at the ground level. Your bones.

Your bones are always being built up and broken down. The rate at which the bone is broken down slowly starts to exceed the rate at which the bone is being built up as you age.

Bone changes cause:

  • a reduction in facial height
  • Increase in facial width and depth
  • The fat pad under the eye to bulge
  • A change in the shape and projection of the chin

Teeth

Injury and periodontal diseases result in loss of teeth, and it’s not like when you were young and the tooth fairy came and left you a dollar and a new tooth grew in (I hear with inflation it’s like $5 now!).

Loosing teeth affects the jaw bone and the muscles which attach to the jaw bone, which can result in make the face look narrower, hollow, and concave on profile.

Taking care of your teeth is super important, and not just for that pretty smile!

Fat Compartments

Collapsing fat compartments in the cheeks and temples reduce support to the overlying skin (side note: don’t worry! These fat cells go to other places… like your hips! j/k).

Splitting the face into thirds


Upper Third

Most people miss this when they look into the mirror at their aging face, but loss of fat in the temples results in the phenomenon I like to call “peanut head, ” which is also noticeable on super athletic people.

The presence of peanut head reflects a lack of support of the outer brow, which, along with loss of subcutaneous fat in the upper lid, causes the appearance of a droopy upper brow.

Blephroplasty anyone?  (Observing Surgery: Blepharoplasty.)

Middle Third

Eye sockets become wider and longer, resulting in a bulge of the cushiony fat pad that lies underneath the eye.

The cheeks start to flatten out, and the fat from the cheek descends to create a deep nasolabial fold.

The tear trough (area where eye skin and cheek skin meet) becomes noticeable. The middle third no longer has that fluid contour. This loss of fullness and form change causes shadowing in the trough, making a person appear to have dark circles, resulting in a tired appearance (just one of the things that causes dark circles).

Angles of the nose change, giving the appearance of increased length and the tip of the nose begins to droop.

Decrease of collagen and increase in tooth display at rest cause the upper lip to lengthen. Fun Fact: the upper lip can stretch by almost 4mm as you age.

(Stolen from another site…shhhh…) Image A shows a youthful face. Look at the contouring from the eye to the cheek. As you age, it can be convex like image B, which shows the fat pad bulging, or it can be concave like image C, making the eyes look hollow. Both B and C show a flat cheek when compared to Image A.

Lower Third

With all this stuff happening in the upper portions of the face, skin sags and starts to hang in the lower third. Adding insult to injury, the angle of the jaw changes, the jaw line, becomes less defined, and the chin shortens. Excess skin droops from the jaw line from gravity and loss of elasticity. Loss of ligament support in the jaw leads to the formation of jowls.

Even with droopy skin, the lower portion of the face starts to look smaller than the upper and middle third.

advancedskinwisdom.com a

(This image was also stolen).

What are your options?

Don’t worry. There are things you can do for volume loss! They do NOT include Oil of Olay, although the new commercial on tv claims it can (they lie).

Injections

For advanced volume loss, Sculptra is really the best injectable product. This product is a biostimulator; it works by stimulating your body’s own natural collagen. Results are the most natural of all the fillers, and the product lasts 2 years. I plan on writing a lot more about Sculptra, so stay tuned!

If you aren’t mentally or financially ready to jump into Sculptra, Radiesse is a wonderful thick, volumizing filler. It is usually my product of choice for cheek augmentation, naso-labial folds, and marionette lines.

For tear troughs, I LOVE Belotero (which is made by the same company as Radiesse). Filling this area literally takes ten years off your face, but remember, it is a very advanced procedure. Stick to a friend’s referral as to who to go to; I have seen a lot of over treated troughs!

For more help with fillers, check out What Goes Where?.

Surgical

Another option is fat transfer. I have assisted in several fat transfers; it is a very interesting procedure. If you are planning on liposuction, I highly suggest inquiring about fat transfer as well.

For sagging skin around the neck and jaw line, surgery is the only real option to date.

XOXO, old LK

(I found the ‘Age My Face’ Ap… yes… there’s an ap for that!)

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