Endocrinology: The Ageing Face

Question 1

What is ageing?

Answer 1

• Result of both superficial textural wrinkling of the skin and 3D changes of the underlying structures
• Skin
• Soft tissues (fat, muscle and fascia)
• Bone and teeth)

Question 2

What are the major forces of ageing?

Answer 2

• Gravity
• Progressive bone resorption
• Decreased tissue elasticity
• Redistribution of subcutaneous fat
• Chronic sun exposure smoking
• Stress, diet, drug use

Question 3

What happens to skeletal components with age?

Answer 3

bone atrophy, decrease facial height, modest increase in width, orbits increase, maxilla decrease in size, coarsening of muscular insertion points

Question 4

What happens to subcutaneous fat distribution with age?

Answer 4

diffuse, well balanced superficial and deep fat changes; loss of soft tissue fullness in certain areas (periorbital, forehead); persistence of fat in others (submental, nasolabial folds, jowls)

Question 5

What upper to the upper third of face with age?

Answer 5

Upper third (forehead and brows)
- Loss of subcutaneous fullness
- Underlying bones are accentuated
- Eyebrow ptosis
- Intrinsic muscle tone of glabellar, procerus and frontalis muscles lead to fixed wrinkles and folds

Question 6

What happens to middle third of face with age?

Answer 6

Middle third (midface)
- Loss of fullness in malar prominence
- Buccal hollowing
- Crow’s feet
- Palpebral bags
- Darker colouration to lower eyelids
- Ptosis of cheek ad
- Lengthening of nose
- Ptosis of nasal tip
- Chin pad ptosis

Question 7

What happens to lower third of face when ageing?

Answer 7

• Skin excess
• Loss of definition to jawline
• Facial jowls: descent of facial fat and skin to mandible border
• ‘Turkey neck’ deformity

Question 8

Management of ageing for patients

Answer 8

• Understanding these changes leads to development of strategies to assist patients
• Fat injections, botox, face lifts, zygomatic on-lay bone grafts, genioplasty, denture construction, sinus lift procedures and associated grafting procedures for dental implants
  Topical treatment
• Tretinoin: reduces oxidative radicals, inhibits keratinocyte differentiation, stimulates epidermal hyperplasia

Question 9

Changes to facial skin with age

Answer 9

• The skin is the envelope of the face that reveals the deflation and atrophic changes of the underlying bone and soft-tissue compartments
• Skin also goes through intrinsic changes: epidermal thinning, solar elastosis, dermal collagen disorganised, increased pigmentation, increased production of intracellular reactive oxidative radicals