Look at a group of youthful faces, and you will notice they have one thing in common: volume. This look of fullness results from skin having the necessary structural support to look smooth and supple, and to reflect light. And while the etiology of volume loss may be attributed to many factors, modern, integrative approaches to volume restoration address both the underlying cause and visible effects.
Volume loss is one of the primary signs of aging. As facial volume naturally diminishes, skin is no longer stretched as tightly over the surface, creating areas marked by hollowing, shadows and folds (think of a “deflating balloon”). Anatomic changes—shifts in bone and loss of bony mass (“osteoporosis”)—cause skin and soft tissue to drape differently, affecting multiple areas of the face.
The skin itself also suffers from the simultaneous breakdown of existing collagen and elastin, and the decreased capacity to generate new structural proteins, causing increased laxity and sagging.
One of the first facial areas to be affected, the midface, is comprised of three parts: the zygoma (or cheekbone), the apple, and the submalar hollow, where hollowing occurs. As we lose cheek volume, tissue itself slides down, causing the cheeks to sink and often worsening nasolabial folds. Further reduction in volume can leave us with jowls, the unattractive loose skin sagging from where our tight jawline used to be.
Women in particular can lose up to 40 percent of their mandible. The eye socket also recedes, causing the orbital area to appear hollow and sunken. The bridge of the nose may lose bone and start to droop slightly with age. And one can’t overlook the temples, which start to create an overall look of gauntness as they deflate, causing a concavity that affects surrounding areas like the eyebrows.
Fat, too, plays an important role in giving the face youthful-looking roundness. Therefore, it stands to reason that lifestyle changes, such as illness, dieting, increased exercise or other causes of extreme weight loss will start to affect facial fullness, typically after a weight loss of 10 pounds or more. Loss of estrogen during and after menopause depletes the skin of needed fat as well.
Whatever the cause, comprehensive treatment for volume loss focuses on the end goal of restoration. Dermal or “wrinkle” filler options have evolved over the years, increasing in both variation and efficacy. Once the only dermal filler option available on the market, collagen fillers—limited by their typically higher risk of allergic reaction—have pretty much disappeared from the market and have been replaced by more sophisticated options such as hyaluronic acid, or HA – based fillers such as the various Juvederm and Restylane products on the market.
Hyaluronic acid truly revolutionized the filler market, as its duration almost doubles that of collagen without a serious risk of allergic reaction. Furthermore, popular hyaluronic acid fillers may be catered to the needs of the patient, and their versatility means they can be used virtually anywhere on the face, as well as the back of the hands, etc.
One of HA’s primary benefits is that it can hold up to 1000 times its weight in water, but this also means that HA fillers have the potential to create a doughy or puffy appearance. Because no patient should display the telltale signs of unnatural-looking filler, any unsatisfactory results can be corrected by injecting the treated area with hyaluronidase, an enzyme that in trained hands can dissolve some or all of the hyaluronic acid (essentially an antidote if you weren’t completely satisfied).
For those patients with, well, patience, there are methods of creating and stimulating your own collagen. In-clinic procedures such as Dermaroller, skin resurfacing lasers such as Profractional Laser, and Laser Genesis will help you to build your own collagen over time. Each procedure is independent in that each time the procedure is completed, collagen will begin to fill out the grooves and crevices. Multiple sessions can lead to a desired result, whether for anti-aging or scar reduction. I will often suggest injectables to start with, so that the patient is pleased with their look while beginning the task of creating their own collagen, which can last for years.
Whether injecting or using one of the above treatments, or both, I always suggest adding the best in home care. Products containing Growth Factors and Vitamin C will help to build collagen, while Retinols and products containing HA will continue to smooth the skin. Colhy Gel and Elasty Gel by Clayton Shagal go right to the dermis to fill in the lines and add hydration and stability to the skin, particularly nice around the eyes.
Though no one is exempt from aging, we all have the power to decelerate the process. By addressing some of the primary underlying causes—sun exposure, free radical damage—and taking proactive steps toward restoring the volume and fullness to our faces, we can definitely slow down the clock.
~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre