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Harvard Health Letter
Harvard Health Letters
Between acceptance and defiance there's a middle way of relatively small tweaks that will make an old face look younger.
Age affects every nook and cranny of the body, but nowhere are the consequences on such open display as on our faces. Dozens of changes take place as the years add up, some of them obvious and familiar: Foreheads expand as hairlines retreat, for example. Ears of an older vintage often get a bit longer because the cartilage in them grows. Tips of noses may droop because connective tissue supporting nasal cartilage weakens.
There are also structural rearrangements going on behind the scenes. When we're young, fat in the face is evenly distributed with some pockets here and there that plump up the forehead, temples, cheeks, and areas around the eyes and mouth. With age, that fat loses volume, clumps up, and shifts downward, so features that were formerly round may sink, and skin that was smooth and tight gets loose and sags. Meanwhile, other parts of the face gain fat, particularly the lower half, so we tend to get baggy around the chin and jowly in the neck.
The bones in the face also change with age. Like the rest of the skeleton, the upper jaw, lower jaw, and cheekbones shrink. Less bone can make a face look wider and more angular and contributes to looser skin.
And, of course, there are the wrinkles. Those deep ones in the forehead and between the eyebrows are called expression, or animation, lines. They're the result of facial muscles continually tugging on, and eventually creasing, the skin. Other folds may get deeper because of the way fat decreases and moves around.
Finer wrinkles are due to sun damage (more on that below), smoking (which has some of the same effects on skin as sunlight), and natural degeneration of elements of the skin that keep it thick and supple.
WHAT TO DO ABOUT IT
If our faces show our age, so be it -- in fact, we should celebrate it. Some lines here and there connote character. That's one -- and perhaps the best -- response to age etching itself into our faces. And American attitudes toward an older look seem to be shifting now that many baby boomers are in their 60s.
Counter to "old and proud of it" is the age-defying facelift, which surgically removes excess tissue and -- as the name indicates -- lifts sagging skin in the lower part of the face. Facelifts have improved, so people look more natural afterward. But the surgery is expensive (the surgeon's fee alone averages just under
Plenty of Americans still get facelifts. According to the
Most of these rejuvenating procedures are nonsurgical. And while they're not inexpensive -- especially when you factor in the need for repeat treatments -- you don't need a movie star-sized income to afford them, nor a star's vanity. "Getting a little work done" has become increasingly mainstream.
Here's just a sample of the things that you can do -- or get done -- to give your face a more youthful appearance:
Sun protection.
As we get older, the collagen in the dermis -- the next-to-the-top layer of the skin -- changes character, so the skin feels thinner and stiffer. Add sun exposure and you get solar elastosis: tangles and clumps of collagen and elastin (a protein that, as the name suggests, makes skin springy). With solar elastosis in the dermis, the skin loses its flexible, supporting structure, so fine wrinkles form around the mouth and across the cheeks. Sun exposure is also the main cause of crow's feet, the wrinkles at the outside corners of the eyes.
Protecting your face from the sun is the single best way of keeping it youthful, according to Dr. Kenneth Arndt, a member of the
Creams and lotions.
Moisturizers soothe dry skin and may temporarily make wrinkles less noticeable. Moisturizers for the face contain water to make them less greasy, and many have substances -- glycerin, for example -- that may help bind water to the skin. Exfoliant creams can improve the appearance of older skin by getting rid of dead skin cells that don't slough off as readily as they did when we were young.
Several prescription creams (Avita, Avage, Renova, Retin-A) have been shown to reduce wrinkles and so-called liver spots caused by sun exposure. These
Using a retinoid cream is a fairly pricey proposition. A single tube costs between
Dozens of products containing other vitamins and ingredients are available. For the most part, there isn't much evidence for these "cosmeceuticals" having much of an effect. More often than not, they're probably not worth the money.
Botulinum toxin injections.
These injections are used to treat the expression lines of the forehead and between the brows. They work by partially immobilizing the muscles that form expression lines so the skin smooths out, although some deep expression lines may not go away. Botox is the familiar brand name. Other
Botulinum toxin injections cost between
Dermal fillers.
Dermal fillers are used to treat lines created by lost collagen and fat. After Botox injections, dermal filler injections are the most common cosmetic procedure performed in the U.S. Prime locations for the injections are two sets of parentheses: the pair of lines that extend down from the nose to the corners of the mouth, known as the nasolabial folds, and another pair that extends down from the corners of the mouth to the chin, known as marionette lines.
Many different materials are used as dermal filler. Collagen has fallen out of favor. Currently, the most popular one is hyaluronic acid, a complex sugar found naturally in many tissues. As a filler, it expands the dermis by occupying the spaces between collagen and elastin. Hyaluronic acid is more expensive than collagen but lasts longer -- up to six months in the nasolabial folds. Injections cost between
Laser treatments.
Lasers can be used to home in on certain pigments: brown, if the goal is to get rid of freckles and liver spots, red if the target is broken capillaries. They're also used for wholesale resurfacing of facial skin. The uppermost layers are stripped away, and with them, wrinkles from sun damage and scars from acne. In effect, the skin's wound-healing capabilities are being harnessed, explains Dr. Arndt, who performs many laser procedures: smoother layers of tissue replace the old, damaged layers that have been lasered away. The energy from some "nonablative" resurfacing lasers passes through the outer layer of the skin to work at a deeper level, in the dermis, to stimulate inflammation, which leads to collagen formation.
Skin needs time to recover after most laser treatments. It can take a couple of weeks to heal, depending on the type and extent of the treatment. The nonablative treatments tend to heal a bit faster.
Treatments vary in price. For pigmented or vascular lesions, charges range from
Eyelid surgery.
The medical term for eyelid surgery is a pleasing mouthful: blepharoplasty. Eyelids sag and get puffy for several reasons. With age, the little muscles that support your eyelids weaken. Extra skin and fat accumulate, so they look puffy. If the upper eyelid droops too low, it can block your vision. Almost 150,000 Americans had blepharoplasty in 2009, and it's the most common cosmetic surgery among people over 50. The procedure involves removing the excess skin and fat, so the eyelids tighten up. Sometimes the fat can be removed through the palpebral conjunctiva, the membrane that lines the inner surface of the eyelid, without making an incision.
People may get other procedures done at the same time as blepharoplasty to improve the appearance of the whole area around the eye. The average surgeon's fee for blepharoplasty is slightly under
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Health - The Aging Face: Small Tweaks Can Help You Look Younger