You can have a full aesthetic assessment at Clinica London by Jane Olver and her team of nurses. We address the face and the periorbital area (the area around the eyes). We can broadly divide the examination at a full aesthetic facial assessment into three sections:
In particular, I am looking at your skin quality and also skin quantity. Concerning skin quality, I want to know whether you have wrinkles that bother you, whether you have rosacea or acne, age spots, hyperpigmentation, sun damage, melasma, broken veins and capillaries.
I also want to know whether your skin looks healthy, whether it has luminance and life about it, or whether it is dull and lacklustre.
Once I have looked at the skin quality and quantity I then ask myself whether there are factors in your lifestyle and diet that can be changed to improve skin quality such as giving up smoking, using Tretinoin cream and improving nutrition and protecting from further some damage from both UVA and UVB.
I also want to know whether the apparent skin excess that you may have is actually due to skin excess or is due to loss of volume or facial descent (soft tissue).I, therefore, look with you using the mirror so we are both seeing what I am pointing at and I examine the temples for loss of volume, then the tear troughs and trans-cheek groove, the nasojugal groove, the nasolabial groove and the marionette lines below the mouth.
I also look at the shape of the jowl at the jawline as there can be jowling from tissue descent, not just skin laxity.We spend some time looking at the skin surrounding the eyes as I am an ocular plastic surgeon and can provide a lot of advice on deep tear troughs and prominent palpebral malar groove which is the extension of the tear trough under the eye in a curve.
When examining apparent loss of volume, I use my fingers to move the underlying soft fat in the face to try and demonstrate to the patient how they would look with better volume.
All the time while I am examining your face and around the eyes, I am looking to see whether you look aged, whether your eyes are aged, whether your face looks tired.
I think simultaneously about the possible treatments that I can offer to improve skin quality, to either use the skin quantity you have or reduce it or to improve the volume and overall shape of the face and correct the apparent soft tissue descent and loss of volume.
I also look at the underlying skeleton, the bony shape that you were born which constantly changes during life. As we age, we get some bone resorbed from our upper outer orbit, from our mandible and from parts of our maxilla, all of which contribute to a change in the appearance of the envelope of soft tissue and skin.
I look to see whether there are asymmetries, which have probably been present all your life but are becoming more apparent as you age.For this, I even look at your teeth as your dental bite often mirrors facial asymmetries.
However, when I do an aesthetic facial and periorbital assessment I have to concentrate on what concerns you, the patient, what you are worried about, what your friends and family may have commented on, which part of your face you are finding is out of proportion with the rest of your face.
Very rarely do I get asked, “Doctor, please assess me and just tell me what you think I can have done”.It is much more important for me to know what you want and then I tell you after I have examined you whether realistically that can be helped.
In my next blog post, I will talk about what treatments I can offer for skin quality and quantity and loss and descent of soft tissue volume as well as for inherent bony facial asymmetry.