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Creating an attractive aging face

2012; Wiley; Volume: 11; Issue: 3 Linguagem: Inglês

10.1111/j.1473-2165.2012.00632.x

1473-2165

Zoe Diana Draelos,

Hair Growth and Disorders

Concepts of attractive female facial rejuvenation seem to change as new technologies become available. In some ways, techniques follow the currently popular media face of the moment. These trends are important to cosmetic dermatology because they set forth patient expectations as to what constitutes a good outcome. I have found analysis of these trends interesting and hope to shed insight into the cosmetic rejuvenation of the aging face with a window to the future. The first approach to cosmetic improvement of the female face began with the desire of the French upper class to minimize the appearance of small pox scars, which were ubiquitous among those fortunate enough to survive the disease. Facial rejuvenation in the 1600s consisted of wearing cloth patches designed to cover facial scars known as beauty patches, which were black silk or velvet pieces shaped like stars, moons, and hearts that were carefully placed about the face. The patches were carried in small patch boxes, the forerunner of the mirrored facial compact, in case they fell off in public and required replacement. The next trend was the application of powder to the face to create the illusion of a smoother complexion. The powder was white and gave a chalky facial appearance, which was fashionable at the time, but did not stay on well and flaked onto clothing. Suspending the powder in a liquid created a cream, known as French White, which was the first modern-type facial cosmetic. The white liquid formed a thin film that dried into place on the face and body, but was water soluble and easily removed with sweating. This problem was overcome with the suspension of the pigments and fillers in an oily vehicle and gave rise to grease paints. These were popularized in the theater and soon consumers also wanted to get the white complexions they observed on the stage. The availability of grease paints to the consumer market was really the birth of the cosmetics industry. Max Factor is credited with developing the first widely marketed cake make-up in 1936. Pigment was added to these cosmetics, and the movement toward a more natural skin color over the white pastes became a new trend. The goal here was to create an attractive face by minimizing discoloration. The use of facial foundation still remains an important part of creating an attractive aging face, but this technique did not address issues of wrinkling or facial proportions. Next, the issues of wrinkling of the aging face and skin redundancy were addressed and the field of facial plastic surgery was born. Facelifts were invented and the excess skin from the eyelids was pulled and cut along with the excess skin from the cheeks. This removed folds from the face, and the dyspigmentation issues were addressed with facial cosmetics. The skeletonized female face became the norm as the skin was pulled tighter over a face devoid of subcutaneous fat; however, women did not necessarily look younger following this type of facelift; they only possessed fewer facial folds. Furthermore, the facelift did not address fine lines of the face and other skin texture issues. The need to address wrinkles and lines led to the development of injectable materials to fill in wrinkles of the face. The first injectable was bovine collagen, currently unavailable, to fill in nasolabial folds and lip rhytids. Also, Gortex tubes were created into which collagen could grow to fill in nasolabial folds. These were the first permanent cosmetics and represented an advance from the prior temporary cosmetics. There were problems with the need for skin testing to prevent allergic reactions to bovine collagen and foreign body issues of extrusion and infection with the tubes. Collagen gave way to hyaluronic acid fillers, which did not require a skin test and had an increased longevity over the first bovine collagen products. Hyaluronic acid fillers were also injected into wrinkles and fine lines to reduce their depth. While filling in wrinkles appeared to have value around the mouth, there were some issues with wrinkles at rest and wrinkles at motion. Aging women did not want to look good only when the face was not emoting and the concept of chemodenervation was invented allowing the introduction of facial botulinum toxin injections. Chemodenervation allowed reduction in wrinkles from frowning between the eyes, forehead lines from raising the eyebrows, and lateral eye crow’s feet from smiling. This is where we stand today. What are the problems and the unmet needs? The main problem is that even with botulinum toxin injections and filler injections and modernized technique facelifts, the aging female face still looks old. The concept has been advanced that it is the change in facial proportions that ages the face with the facial triangle having the point on the chin in youth and the facial triangle having the point on the forehead in the aging face. Thus, with time, the facial triangle completely inverts. The newest concept in facial rejuvenation is facial volumizing where the malar fat pad is replaced and volume restored to the upper face. Replacing the malar fat pads minimizes the jowls, nasal labial folds, and marionette lines, but the aging face still does not look young with this rejuvenation. Many women have fewer folds, but they look as if they have gained 5–10 pounds with a chubbier face. Fillers are commonly combined with botulinum toxin. While these women look good when not emoting, smiling, frowning, or laughing result in either too little facial movement or unnatural movement from recruited muscles. The women look strange when their face is in motion, fat when their face is at rest, and still possess an aged appearance. Is this attractive? Again, it is up to the media norms that are put forth. The use of botulinum toxin has greatly increased in female news reporters on television. Their mouths move, but their forehead and eyes do not. This is the new norm and even 20–30-year-old females are looking to exhibit no glabellar folds. Are they looking younger with a botulinum toxin-treated face? These are important questions for the cosmetic dermatologist to consider. The historical approach is valuable to allow us to see where we have been and where we are going. The current trend toward the use of filler to volumize rather than simply filling wrinkles presents new opportunities to define the attractive aging face, but this is not the complete answer. The real solution to the problem is to redefine the attractive aging face at an older age than 16 years. Sixteen years is simply too hard to replicate because the human is not fully mature. Until physical and mental maturity is reached around 25 years and growth has ceased, the body does not reach any type of static equilibrium. As the average age of society increases, this redefinition of youth is bound to occur as the media markets to target populations where sales are occurring. The declining birth rate may redefine the goals of cosmetic dermatology. The future will definitely be interesting!