July 8, 2025
Facelift Series #3: Facial Aging w/ Dr. Kylie Edinger
When we’re young, our faces have a smooth, full look thanks to well-defined fat pads and tight connective tissue. But as we age, those structures start to change, leading to sags, bags and changes in facial shape.
Facial aging doesn’t happen all at once. It’s a gradual process that starts as early as your 20s. At first, the face can look more sculpted and angular, but over time, fat volume loss, drooping, and eventually muscle and bone changes become more noticeable.
Restoring a youthful look often means going beyond just the skin. It takes a thoughtful approach that can include restoring lost volume, repositioning fat and connective tissue, and tightening the skin.
Drs. Bass and Edinger break down how facial aging really works, from the inside out, and why understanding these changes is key to treating them effectively.
Learn more about facelift surgery
About Dr. Kylie Edinger
Dr. Kylie Edinger is a plastic surgeon currently spending a year training as an aesthetic plastic surgery fellow with Dr. Bass and a host of other world class plastic surgeons at Manhattan Eye, Ear, and Throat Hospital in New York City. She’s part of the prestigious Northwell Health program—one of the top aesthetic plastic surgery fellowships in the country. Before making her way to NYC, Dr. Edinger completed her plastic surgery residency at the University of Wisconsin.
Follow Dr. Edinger on Instagram @kylieedinger
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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00:00:01,050 --> 00:00:03,600
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,660 --> 00:00:07,320
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,320 --> 00:00:10,140
surgery. I'm your co-host, Summer Hardy,
4
00:00:10,230 --> 00:00:13,380
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,680 --> 00:00:17,550
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:00:17,610 --> 00:00:19,650
educator and technology innovator.
7
00:00:20,460 --> 00:00:24,660
Today's episode is number three in
our facelift series, Facial Aging.
8
00:00:25,230 --> 00:00:28,530
What are principals involved in facial
aging and why are they important?
9
00:00:29,160 --> 00:00:33,270
Surgery is all about
anatomy and structure,
10
00:00:33,270 --> 00:00:37,800
so it's really important to
understand normal youthful
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00:00:37,800 --> 00:00:42,540
anatomy and then understand
how that changes with
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00:00:42,540 --> 00:00:43,373
age.
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00:00:43,650 --> 00:00:48,270
That teaches us how to restore
it to a youthful state.
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00:00:48,840 --> 00:00:52,140
The basic structure of the faith in youth,
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00:00:52,710 --> 00:00:57,210
we have skin, connective
tissue, subcutaneous fat,
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00:00:57,330 --> 00:00:59,250
a fibroseptal network,
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00:00:59,580 --> 00:01:03,630
and then there are
thicker areas within this.
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00:01:03,630 --> 00:01:06,510
So we start with the skin at the surface.
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00:01:06,510 --> 00:01:09,990
Underneath the skin is a layer of fat.
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00:01:09,990 --> 00:01:13,680
Even in thin people, there's
a little bit of fat there,
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00:01:13,680 --> 00:01:17,700
and some thicker fat pads
that make some of the
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00:01:17,700 --> 00:01:19,800
shapes in the face.
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00:01:20,010 --> 00:01:24,870
Underneath the fat is connective
tissue that sits over the
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00:01:24,870 --> 00:01:25,650
muscle.
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00:01:25,650 --> 00:01:30,480
That's the SMAS layer or Superficial
Muscular Aponeurotic System.
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00:01:30,840 --> 00:01:33,810
It's a connective tissue
layer over the muscle.
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00:01:34,470 --> 00:01:39,150
What runs through the
fat in between the skin
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00:01:39,450 --> 00:01:43,170
and the connective
tissue are little fibers,
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00:01:43,230 --> 00:01:48,000
connective tissue fibers made
of collagen that hold the skin
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00:01:48,000 --> 00:01:50,640
down against the underneath.
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00:01:50,880 --> 00:01:55,230
That's why our skin doesn't pool
around our ankles and around our
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00:01:55,230 --> 00:01:59,610
waist and around our jaw
because it's held in place,
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00:01:59,790 --> 00:02:01,290
particularly in youth.
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00:02:01,650 --> 00:02:06,510
And there are certain areas where those
connective tissue fibers are thicker
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or coalesce,
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00:02:07,890 --> 00:02:11,820
and that creates a strong
fixed attachment point,
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00:02:12,000 --> 00:02:14,460
what we call a ligament,
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00:02:14,490 --> 00:02:18,720
even though it's technically
not a ligament like the
orthopedic surgeons need,
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00:02:19,110 --> 00:02:23,610
and those ligaments
compartmentalize the fat
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00:02:23,610 --> 00:02:27,000
layer into those discreet fat pads.
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00:02:27,650 --> 00:02:28,980
Okay, and what happens to skin with aging?
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00:02:31,590 --> 00:02:32,460
Well, as we age,
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00:02:32,460 --> 00:02:37,110
our skin undergoes intrinsic changes due
to the natural aging process and also
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extrinsic exchanges due to environmental
exposures and influences like sun
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00:02:41,730 --> 00:02:45,570
smoking, hydration in
your diet. Over time,
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00:02:45,570 --> 00:02:49,290
our skin produces less collagen
and elastin leading to laxity,
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and it also offends as we age,
making it more prone to wrinkles.
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00:02:53,370 --> 00:02:57,810
We see all these changes below the skin
and in deeper structures of the face as
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00:02:57,810 --> 00:02:58,890
well as we age.
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So Dr. Edinger has just
outlined a multitude of factors
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that are affecting our face
that affect the aging appearance
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of the face. In the old days,
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we thought it was just the
skin becoming less elastic,
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but now we understand that there
are many other things involved,
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and that means we have
to engage with those
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00:03:24,100 --> 00:03:28,780
anatomic structures and the
changes in those structures if we
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want to restore the face.
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That makes sense.
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00:03:33,580 --> 00:03:37,330
So what are these changes in the
rest of the facial structures?
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When we start out in youth but grown up,
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let's say in our twenties, we
have typically the baby face.
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Most people in their twenties
still have a lot of fullness in the
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face,
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and we recognize unconsciously just
when we glance at someone that that
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person is young. As we age,
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00:03:59,650 --> 00:04:01,930
start to come out of our twenties,
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00:04:01,960 --> 00:04:04,990
we start to lose fat in the face,
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00:04:05,260 --> 00:04:10,060
and that means we're losing
volume. Our shape is changing,
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00:04:10,060 --> 00:04:13,120
flattening. We're losing
some of the projection,
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00:04:13,120 --> 00:04:17,440
particularly early on in the
midface, but eventually everywhere.
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00:04:17,740 --> 00:04:22,570
And that progresses at first
to a little more sculpted look.
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In our thirties,
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we typically have a little more
angular sculpted look to the face.
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That may be our best look.
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But the problem is the
fat loss doesn't stop.
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It continues and it eventually
becomes too much of a good thing.
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We not only lose the
chubbiness of the baby face,
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00:04:43,270 --> 00:04:48,220
but we start to actually
sink in and hollow. And if we
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think of people who are very
much older, you see that worn,
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00:04:52,720 --> 00:04:57,610
haggard and hollowed out look
that the face assumes with
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00:04:57,610 --> 00:05:02,260
the extremes of age. So
it starts as fat loss,
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00:05:02,260 --> 00:05:07,120
but when we get into our later
fifties and certainly in our sixties,
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00:05:07,120 --> 00:05:11,530
we're also losing muscle volume and we're
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losing bone mass.
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So the shape of our facial bones
that provide the underneath
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scaffolding for the face
are starting to thin,
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00:05:21,910 --> 00:05:24,220
recede and flatten,
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00:05:24,430 --> 00:05:28,840
and that gives us a loss of
projection in the face and a
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00:05:28,840 --> 00:05:33,460
change in the shape of the face
to more of an aging change.
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In addition to that later
progression of loss of fat
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means that we get an
emptying or a volume loss as
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well as a descent of fat pads.
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But the important thing to
understand is that each fat pad
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00:05:51,670 --> 00:05:56,380
loses a different amount and
descends a different amount.
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And in addition to the fat pads changing,
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00:05:59,780 --> 00:06:04,340
we get atrophy of those ligaments
or connective tissue fibers.
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They become less elastic and we
believe they lengthen or stretch
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00:06:08,990 --> 00:06:09,560
out,
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and that contributes to
sagging of the fat that
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00:06:14,480 --> 00:06:16,310
was up in certain places,
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00:06:16,310 --> 00:06:20,930
like against our chic bone
that now sags down lower and
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creates sags, bags,
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bulges in the face that are
noticeable as aging changes
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and not a youthful shape.
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00:06:30,110 --> 00:06:34,730
So all of that changing in
the fat pads means what was
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confluent and smooth in youth now shows as
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individually identifiable
shapes, sags and bags,
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and that's amplified by the
loss of skin elasticity and
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thickness. These young springy,
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elastic full skin holds everything into
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a smooth confluent shape.
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So even shapes on the face that look
like single shapes like our cheek are
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00:07:03,050 --> 00:07:06,200
actually made up of multiple fat pads,
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00:07:06,380 --> 00:07:11,270
as well as multiple layers
of fat pads and all of that.
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As it starts to lose elasticity,
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00:07:14,300 --> 00:07:18,260
sag as skin thins will show itself,
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everything changes the skin,
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00:07:21,140 --> 00:07:25,430
the connective tissue or
SMAS layer, muscle and bone.
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00:07:25,700 --> 00:07:27,650
So overall,
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00:07:27,680 --> 00:07:32,570
you're getting a change
between the skin and the SMAS,
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and you're getting a change in the amount
of volume that's interposed between
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those two tissue layers.
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And these altered relationships
between the layers in
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conjunction with the volume loss
are the main culprits of an aging
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appearance in the face.
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00:07:50,630 --> 00:07:52,970
Thank you for outlining all
those changes, Dr. Bass.
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Are there any other changes to consider?
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We also see a separation in the neck
platysmal muscle that we refer to as a
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diastasis,
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where that midline muscle edge begins
to separate and can lead to platysmal
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00:08:05,600 --> 00:08:09,410
banding and a more obtuse
angle below the neck over time.
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Okay, so I'm starting to get a handle
on the aging changes on the inside.
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What does that translate to
and what we see on the outside?
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00:08:18,380 --> 00:08:19,190
On the outside,
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patients will notice all of the things
that bother patients and prob them to
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00:08:23,000 --> 00:08:24,740
potentially seek out a facelift surgery.
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So we'll see deepening of nasolabial
folds, jowling, marionette lines,
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00:08:29,930 --> 00:08:34,340
platysmal banding, skin laxity,
hollowing with loss of volume.
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00:08:34,760 --> 00:08:38,810
So the face takes on a more rectangular
shape as it ages in contrast to the
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00:08:38,810 --> 00:08:41,180
softer heart shaped face
of the youth as well.
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00:08:42,080 --> 00:08:45,530
Right? That's sort of a
squaring out of the face.
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Normally,
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our cheekbone area is the widest
part of the face in youth,
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the youthful face kind of looks like an
upside down egg with the thin part on
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the bottom and the wider part on top.
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00:08:58,800 --> 00:09:01,380
As we age and everything sags down,
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00:09:01,740 --> 00:09:06,300
the mid portion narrows flattens and loses
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00:09:06,300 --> 00:09:09,900
projection, and the
bottom part widens out,
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00:09:09,900 --> 00:09:12,960
and we come to that more
rectangular appearance.
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00:09:14,070 --> 00:09:16,410
Okay, and now time for takeaways.
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Aging changes in the face
are going on from early
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00:09:21,810 --> 00:09:25,080
on in our adult face in our twenties,
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00:09:25,230 --> 00:09:30,030
and some of those early changes
give us a little more definition in
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our appearance. However,
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00:09:32,100 --> 00:09:35,130
with the progression of aging,
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00:09:35,310 --> 00:09:40,170
the accumulation of volume
loss in the fat loosens our
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00:09:40,170 --> 00:09:44,850
face and also changes our
facial shape, as you just heard.
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Dr. Edinger describe.
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00:09:46,860 --> 00:09:51,450
So we restoring a youthful
face ends up being
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00:09:51,450 --> 00:09:56,040
about restoring all of the tissue layers
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as needed, restoring fat into the face,
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repositioning fat in the face,
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00:10:02,940 --> 00:10:07,830
repositioning connective tissue
elements like the SMAS layer
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00:10:07,950 --> 00:10:10,350
and repositioning skin.
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00:10:10,950 --> 00:10:15,480
The thing that facelift does not
address is the quality of the
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skin. So it gets positioned
back to its youthful location,
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00:10:19,920 --> 00:10:24,570
but we're not changing
the quality of the skin in
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00:10:24,570 --> 00:10:27,810
terms of its texture,
elasticity, thickness,
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00:10:27,900 --> 00:10:32,250
and that requires a separate
set of treatments to
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broaden out the scope of the
rejuvenation that's taking place.
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00:10:38,220 --> 00:10:38,580
Thank you,
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00:10:38,580 --> 00:10:43,350
Dr. Bass and Dr. Edinger for providing
so much insight into facial aging and
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00:10:43,350 --> 00:10:47,220
essential background for understanding
how facelift approaches these changes.
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00:10:47,610 --> 00:10:50,280
Watch for our next episode
in the facelift series,
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Facelift Fears to find out why
people are afraid of the facelift.
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00:10:54,930 --> 00:10:59,010
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.
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00:10:59,070 --> 00:11:00,990
Follow us on Apple Podcasts,
178
00:11:01,050 --> 00:11:03,270
write a review and share
the show with your friends.
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00:11:03,420 --> 00:11:06,960
Be sure to join us next time to avoid
missing all the great content that is
180
00:11:06,960 --> 00:11:10,500
coming your way. If you want to
contact us with comments or questions,
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00:11:10,500 --> 00:11:11,700
we'd love to hear from you,
182
00:11:11,790 --> 00:11:16,470
send us an email at
podcast@drbass.net or DM us on
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Instagram at
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00:11:23,390 --> 00:11:25,390
@drbassnyc.
00:00:01,050 --> 00:00:03,600
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,660 --> 00:00:07,320
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,320 --> 00:00:10,140
surgery. I'm your co-host, Summer Hardy,
4
00:00:10,230 --> 00:00:13,380
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,680 --> 00:00:17,550
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
6
00:00:17,610 --> 00:00:19,650
educator and technology innovator.
7
00:00:20,460 --> 00:00:24,660
Today's episode is number three in
our facelift series, Facial Aging.
8
00:00:25,230 --> 00:00:28,530
What are principals involved in facial
aging and why are they important?
9
00:00:29,160 --> 00:00:33,270
Surgery is all about
anatomy and structure,
10
00:00:33,270 --> 00:00:37,800
so it's really important to
understand normal youthful
11
00:00:37,800 --> 00:00:42,540
anatomy and then understand
how that changes with
12
00:00:42,540 --> 00:00:43,373
age.
13
00:00:43,650 --> 00:00:48,270
That teaches us how to restore
it to a youthful state.
14
00:00:48,840 --> 00:00:52,140
The basic structure of the faith in youth,
15
00:00:52,710 --> 00:00:57,210
we have skin, connective
tissue, subcutaneous fat,
16
00:00:57,330 --> 00:00:59,250
a fibroseptal network,
17
00:00:59,580 --> 00:01:03,630
and then there are
thicker areas within this.
18
00:01:03,630 --> 00:01:06,510
So we start with the skin at the surface.
19
00:01:06,510 --> 00:01:09,990
Underneath the skin is a layer of fat.
20
00:01:09,990 --> 00:01:13,680
Even in thin people, there's
a little bit of fat there,
21
00:01:13,680 --> 00:01:17,700
and some thicker fat pads
that make some of the
22
00:01:17,700 --> 00:01:19,800
shapes in the face.
23
00:01:20,010 --> 00:01:24,870
Underneath the fat is connective
tissue that sits over the
24
00:01:24,870 --> 00:01:25,650
muscle.
25
00:01:25,650 --> 00:01:30,480
That's the SMAS layer or Superficial
Muscular Aponeurotic System.
26
00:01:30,840 --> 00:01:33,810
It's a connective tissue
layer over the muscle.
27
00:01:34,470 --> 00:01:39,150
What runs through the
fat in between the skin
28
00:01:39,450 --> 00:01:43,170
and the connective
tissue are little fibers,
29
00:01:43,230 --> 00:01:48,000
connective tissue fibers made
of collagen that hold the skin
30
00:01:48,000 --> 00:01:50,640
down against the underneath.
31
00:01:50,880 --> 00:01:55,230
That's why our skin doesn't pool
around our ankles and around our
32
00:01:55,230 --> 00:01:59,610
waist and around our jaw
because it's held in place,
33
00:01:59,790 --> 00:02:01,290
particularly in youth.
34
00:02:01,650 --> 00:02:06,510
And there are certain areas where those
connective tissue fibers are thicker
35
00:02:06,510 --> 00:02:07,740
or coalesce,
36
00:02:07,890 --> 00:02:11,820
and that creates a strong
fixed attachment point,
37
00:02:12,000 --> 00:02:14,460
what we call a ligament,
38
00:02:14,490 --> 00:02:18,720
even though it's technically
not a ligament like the
orthopedic surgeons need,
39
00:02:19,110 --> 00:02:23,610
and those ligaments
compartmentalize the fat
40
00:02:23,610 --> 00:02:27,000
layer into those discreet fat pads.
41
00:02:27,650 --> 00:02:28,980
Okay, and what happens to skin with aging?
42
00:02:31,590 --> 00:02:32,460
Well, as we age,
43
00:02:32,460 --> 00:02:37,110
our skin undergoes intrinsic changes due
to the natural aging process and also
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extrinsic exchanges due to environmental
exposures and influences like sun
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00:02:41,730 --> 00:02:45,570
smoking, hydration in
your diet. Over time,
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00:02:45,570 --> 00:02:49,290
our skin produces less collagen
and elastin leading to laxity,
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00:02:49,560 --> 00:02:52,710
and it also offends as we age,
making it more prone to wrinkles.
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00:02:53,370 --> 00:02:57,810
We see all these changes below the skin
and in deeper structures of the face as
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well as we age.
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So Dr. Edinger has just
outlined a multitude of factors
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that are affecting our face
that affect the aging appearance
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of the face. In the old days,
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00:03:11,560 --> 00:03:15,430
we thought it was just the
skin becoming less elastic,
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00:03:15,880 --> 00:03:19,750
but now we understand that there
are many other things involved,
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00:03:19,750 --> 00:03:24,100
and that means we have
to engage with those
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00:03:24,100 --> 00:03:28,780
anatomic structures and the
changes in those structures if we
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00:03:28,780 --> 00:03:30,880
want to restore the face.
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00:03:32,410 --> 00:03:33,490
That makes sense.
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00:03:33,580 --> 00:03:37,330
So what are these changes in the
rest of the facial structures?
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00:03:37,660 --> 00:03:41,230
When we start out in youth but grown up,
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let's say in our twenties, we
have typically the baby face.
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00:03:45,910 --> 00:03:50,530
Most people in their twenties
still have a lot of fullness in the
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00:03:50,530 --> 00:03:51,340
face,
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00:03:51,340 --> 00:03:55,960
and we recognize unconsciously just
when we glance at someone that that
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00:03:55,960 --> 00:03:59,320
person is young. As we age,
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00:03:59,650 --> 00:04:01,930
start to come out of our twenties,
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00:04:01,960 --> 00:04:04,990
we start to lose fat in the face,
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00:04:05,260 --> 00:04:10,060
and that means we're losing
volume. Our shape is changing,
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00:04:10,060 --> 00:04:13,120
flattening. We're losing
some of the projection,
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00:04:13,120 --> 00:04:17,440
particularly early on in the
midface, but eventually everywhere.
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00:04:17,740 --> 00:04:22,570
And that progresses at first
to a little more sculpted look.
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00:04:22,570 --> 00:04:23,770
In our thirties,
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00:04:23,980 --> 00:04:28,090
we typically have a little more
angular sculpted look to the face.
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00:04:28,090 --> 00:04:30,100
That may be our best look.
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00:04:30,220 --> 00:04:34,000
But the problem is the
fat loss doesn't stop.
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00:04:34,000 --> 00:04:38,440
It continues and it eventually
becomes too much of a good thing.
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00:04:38,740 --> 00:04:42,910
We not only lose the
chubbiness of the baby face,
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00:04:43,270 --> 00:04:48,220
but we start to actually
sink in and hollow. And if we
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00:04:48,220 --> 00:04:52,150
think of people who are very
much older, you see that worn,
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00:04:52,720 --> 00:04:57,610
haggard and hollowed out look
that the face assumes with
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00:04:57,610 --> 00:05:02,260
the extremes of age. So
it starts as fat loss,
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00:05:02,260 --> 00:05:07,120
but when we get into our later
fifties and certainly in our sixties,
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00:05:07,120 --> 00:05:11,530
we're also losing muscle volume and we're
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00:05:11,530 --> 00:05:13,540
losing bone mass.
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00:05:13,600 --> 00:05:17,800
So the shape of our facial bones
that provide the underneath
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00:05:17,800 --> 00:05:21,820
scaffolding for the face
are starting to thin,
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00:05:21,910 --> 00:05:24,220
recede and flatten,
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00:05:24,430 --> 00:05:28,840
and that gives us a loss of
projection in the face and a
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00:05:28,840 --> 00:05:33,460
change in the shape of the face
to more of an aging change.
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00:05:33,790 --> 00:05:38,620
In addition to that later
progression of loss of fat
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00:05:38,680 --> 00:05:43,630
means that we get an
emptying or a volume loss as
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00:05:43,630 --> 00:05:46,900
well as a descent of fat pads.
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00:05:47,080 --> 00:05:51,670
But the important thing to
understand is that each fat pad
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00:05:51,670 --> 00:05:56,380
loses a different amount and
descends a different amount.
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00:05:56,530 --> 00:05:59,600
And in addition to the fat pads changing,
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00:05:59,780 --> 00:06:04,340
we get atrophy of those ligaments
or connective tissue fibers.
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00:06:04,340 --> 00:06:08,990
They become less elastic and we
believe they lengthen or stretch
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00:06:08,990 --> 00:06:09,560
out,
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00:06:09,560 --> 00:06:14,450
and that contributes to
sagging of the fat that
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00:06:14,480 --> 00:06:16,310
was up in certain places,
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00:06:16,310 --> 00:06:20,930
like against our chic bone
that now sags down lower and
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00:06:20,930 --> 00:06:23,090
creates sags, bags,
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00:06:23,090 --> 00:06:28,070
bulges in the face that are
noticeable as aging changes
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00:06:28,070 --> 00:06:29,600
and not a youthful shape.
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00:06:30,110 --> 00:06:34,730
So all of that changing in
the fat pads means what was
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00:06:34,790 --> 00:06:39,440
confluent and smooth in youth now shows as
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00:06:39,470 --> 00:06:43,910
individually identifiable
shapes, sags and bags,
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00:06:43,940 --> 00:06:48,140
and that's amplified by the
loss of skin elasticity and
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00:06:48,140 --> 00:06:50,960
thickness. These young springy,
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00:06:50,960 --> 00:06:55,940
elastic full skin holds everything into
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00:06:55,940 --> 00:06:58,100
a smooth confluent shape.
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00:06:58,100 --> 00:07:03,050
So even shapes on the face that look
like single shapes like our cheek are
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00:07:03,050 --> 00:07:06,200
actually made up of multiple fat pads,
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00:07:06,380 --> 00:07:11,270
as well as multiple layers
of fat pads and all of that.
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00:07:11,270 --> 00:07:14,300
As it starts to lose elasticity,
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00:07:14,300 --> 00:07:18,260
sag as skin thins will show itself,
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00:07:18,590 --> 00:07:20,990
everything changes the skin,
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00:07:21,140 --> 00:07:25,430
the connective tissue or
SMAS layer, muscle and bone.
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00:07:25,700 --> 00:07:27,650
So overall,
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00:07:27,680 --> 00:07:32,570
you're getting a change
between the skin and the SMAS,
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00:07:32,750 --> 00:07:37,220
and you're getting a change in the amount
of volume that's interposed between
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00:07:37,220 --> 00:07:38,720
those two tissue layers.
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00:07:38,870 --> 00:07:43,430
And these altered relationships
between the layers in
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00:07:43,430 --> 00:07:47,960
conjunction with the volume loss
are the main culprits of an aging
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00:07:47,960 --> 00:07:49,490
appearance in the face.
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00:07:50,630 --> 00:07:52,970
Thank you for outlining all
those changes, Dr. Bass.
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00:07:53,630 --> 00:07:54,980
Are there any other changes to consider?
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00:07:56,450 --> 00:08:00,530
We also see a separation in the neck
platysmal muscle that we refer to as a
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00:08:00,530 --> 00:08:01,700
diastasis,
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00:08:01,760 --> 00:08:05,600
where that midline muscle edge begins
to separate and can lead to platysmal
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00:08:05,600 --> 00:08:09,410
banding and a more obtuse
angle below the neck over time.
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00:08:10,340 --> 00:08:14,750
Okay, so I'm starting to get a handle
on the aging changes on the inside.
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00:08:14,810 --> 00:08:17,510
What does that translate to
and what we see on the outside?
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00:08:18,380 --> 00:08:19,190
On the outside,
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00:08:19,190 --> 00:08:23,000
patients will notice all of the things
that bother patients and prob them to
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00:08:23,000 --> 00:08:24,740
potentially seek out a facelift surgery.
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00:08:25,340 --> 00:08:29,870
So we'll see deepening of nasolabial
folds, jowling, marionette lines,
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00:08:29,930 --> 00:08:34,340
platysmal banding, skin laxity,
hollowing with loss of volume.
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00:08:34,760 --> 00:08:38,810
So the face takes on a more rectangular
shape as it ages in contrast to the
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00:08:38,810 --> 00:08:41,180
softer heart shaped face
of the youth as well.
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00:08:42,080 --> 00:08:45,530
Right? That's sort of a
squaring out of the face.
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00:08:45,830 --> 00:08:47,090
Normally,
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00:08:47,600 --> 00:08:52,040
our cheekbone area is the widest
part of the face in youth,
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00:08:52,040 --> 00:08:56,250
the youthful face kind of looks like an
upside down egg with the thin part on
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00:08:56,250 --> 00:08:58,350
the bottom and the wider part on top.
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00:08:58,800 --> 00:09:01,380
As we age and everything sags down,
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00:09:01,740 --> 00:09:06,300
the mid portion narrows flattens and loses
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00:09:06,300 --> 00:09:09,900
projection, and the
bottom part widens out,
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00:09:09,900 --> 00:09:12,960
and we come to that more
rectangular appearance.
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00:09:14,070 --> 00:09:16,410
Okay, and now time for takeaways.
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00:09:17,250 --> 00:09:21,810
Aging changes in the face
are going on from early
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00:09:21,810 --> 00:09:25,080
on in our adult face in our twenties,
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00:09:25,230 --> 00:09:30,030
and some of those early changes
give us a little more definition in
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00:09:30,030 --> 00:09:31,980
our appearance. However,
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00:09:32,100 --> 00:09:35,130
with the progression of aging,
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00:09:35,310 --> 00:09:40,170
the accumulation of volume
loss in the fat loosens our
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00:09:40,170 --> 00:09:44,850
face and also changes our
facial shape, as you just heard.
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00:09:44,850 --> 00:09:46,560
Dr. Edinger describe.
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00:09:46,860 --> 00:09:51,450
So we restoring a youthful
face ends up being
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00:09:51,450 --> 00:09:56,040
about restoring all of the tissue layers
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00:09:56,040 --> 00:10:00,000
as needed, restoring fat into the face,
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00:10:00,090 --> 00:10:02,910
repositioning fat in the face,
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00:10:02,940 --> 00:10:07,830
repositioning connective tissue
elements like the SMAS layer
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00:10:07,950 --> 00:10:10,350
and repositioning skin.
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00:10:10,950 --> 00:10:15,480
The thing that facelift does not
address is the quality of the
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00:10:15,480 --> 00:10:19,890
skin. So it gets positioned
back to its youthful location,
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00:10:19,920 --> 00:10:24,570
but we're not changing
the quality of the skin in
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00:10:24,570 --> 00:10:27,810
terms of its texture,
elasticity, thickness,
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00:10:27,900 --> 00:10:32,250
and that requires a separate
set of treatments to
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00:10:32,340 --> 00:10:37,140
broaden out the scope of the
rejuvenation that's taking place.
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00:10:38,220 --> 00:10:38,580
Thank you,
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00:10:38,580 --> 00:10:43,350
Dr. Bass and Dr. Edinger for providing
so much insight into facial aging and
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00:10:43,350 --> 00:10:47,220
essential background for understanding
how facelift approaches these changes.
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00:10:47,610 --> 00:10:50,280
Watch for our next episode
in the facelift series,
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00:10:50,310 --> 00:10:54,090
Facelift Fears to find out why
people are afraid of the facelift.
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00:10:54,930 --> 00:10:59,010
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.
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00:10:59,070 --> 00:11:00,990
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00:11:01,050 --> 00:11:03,270
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