Patients age 40 to 65 or thereabouts, both men and women, become more concerned about a loss of facial volume, deep-set tear troughs, turkey neck and sun damage.
With ageing, there is a gradual loss of mass in the cheeks and under eye area. Depending on the bony shape there can be some thinning and deepening of the temples. The nasolabial lines become more pronounced. Below the mouth, some marionette lines appear heading down towards the chin, and there is some jowling with a non-linear jawline and under chin sack.
If a patient is under 55 and has loss of volume I usually recommend hyaluronic acid gel volumisation of the temples, cheeks, nasolabial folds, marionette lines aiming to give a natural look that will last approximately one year to 18 months before top-up may be required around about 12 months.
In the group that are aged 55 to 65 or even 70, I recommend volumisation mainly with Sculptra (Poly-L-lactic acid) biostimulation. This approach is often slightly gentler than hyaluronic acid gel filers in as much that it slowly induces collagen reformation and hence volumisation and lifting. These patients may still require some Hyaluronic acid gel such as Restylane into the tear troughs as TearFill since Sculptra is not used directly in the tear troughs.
SculptEyes and SculptVisage are techniques that target the ageing face to maintain and rejuvenate.
We can best treat jowling in this group with Ultherapy, which is a nonsurgical facelift. Under the age of 50, it is most likely that you will only need Ultherapy in the under chin area, jowls, and lower face. As we get beyond the age of 50 many patients will request decolletage, neck and full face.
We do Ultherapy as an outpatient and has virtually no post-treatment downtime. It is done with local anaesthetic cream and oral analgesia and takes between 1 and 2 hours depending on the area to be treated.
If the full treatment is required of decolletage, neck and full face, then we would split that into two sessions, but otherwise, it would be very tiring for both the nurse who provides the treatment and for the patient.
Ultherapy is also very effective around the eyes for helping to lift and rejuvenate the eyebrows and open up the eyes making them look fresher and younger. The eyes can also be opened up to look more alert and less sleepy with a combination of Botox and Hyaluronic Acid Gel filler.
Some patients over 50 or 55 are best treated with eyelid surgery, blepharoplasty or ptosis surgery, as non-surgical treatment alone may not give the best result. In this group, I often do surgery then subsequent maintenance with non-surgical aesthetic treatments.
The skin suffers too because we are no longer so well protected against sun damage and start to have melasma and clumps of pigmentation. There are also small wrinkles that appear and even some deeper ones.
The group of 40 to 65-year-olds are very keen to maintain their youthfulness and also to enhance it. In the group age 40 to 65 (or 70), sun damage begins to be evident.
This age group notices that after they have been in the sun, they tend to freckle more and form clumps or circles of freckles, which then blend and are called melasma and these take a while to go away even after their general tan has disappeared. This patchy pigmentation is very ageing in appearance, and I advise on the management of this.
If needed, we also involve our dermatology consultant, Dr Jennifer Crawley, for the use of stronger medication creams against pigmentation. We provide aesthetic advice on the reversal of pigment, for instance, using Intraceuticals opulence to lighten the skin and the use of products such as Tretinoin in strengths 0.025, 0.05 and 0.1 depending on the skin type and then Pigmanorm which is a combination of Tretinoin 0.1% with Hydroquinone and Dexamethasone. We also strongly advise sun protection against UVA and UVB, for instance, with the Heliocare range.
We can best treat jowling and turkey neck in this group with Ultherapy. I’ll discuss this more in my next post.