Evaluation and management of the ageing face

Question 1

Young faces are characterized by the absence of wrinkles.

Answer 1

T But also arcs and fullness.

Question 2

Evaluation of the ageing face must take into account changes that occur in all levels of tissue.

Answer 2

T Need to approach the ageing changes in each layer separately.

Question 3

Changes in muscle mass and tone are the most substantial contributors to soft tissue changes in ageing.

Answer 3

F Fat is the most substantial contributor.

Question 4

Ultrastructural changes in collagen and elastin lead to coarse rhytides or folds.

Answer 4

F These are more likely due to soft tissue atrophy or muscular movement.

Question 5

Sarcopenia refers to skeletal muscle wastage with age.

Answer 5

T

Question 6

Facial mimetic muscles atrophy with age.

Answer 6

F

Question 7

Repeated facial animation over time, in conjunction with chronic UV exposure, permanently fibrose the skin to the muscle and set in the dermal component of rhytides.

Answer 7

T

Question 8

Lack of subcutaneous fat in the ageing face allows the mimetic muscles to pull the skin along.

Answer 8

T

Question 9

The contour of the mandible changes with age.

Answer 9

F Maxilla.

Question 10

There is an increase in vertical maxillary dimension with retrusion of the lower maxillary skeleton with ageing.

Answer 10

T

Question 11

An overall slight narrowing of the face occurs with ageing.

Answer 11

F Widening.

Question 12

There is an overall increase in the facial height with ageing.

Answer 12

F Decrease.

Question 13

Skeletal remodelling in adulthood changes the facial dimensions to that of an infant, with an increase in the ratio of the maxillary height to the orbital height.

Answer 13

T

Question 14

Craniofacial skeletal aging changes are even more dramatic in edentulous people.

Answer 14

T

Question 15

Ageing causes the orbital rim and anterior cheek to move posterior relative to the cornea, causing the eye to appear proptotic.

Answer 15

T

Question 16

Gravity is responsible for the hallmark shape of the ageing face.

Answer 16

F Fat redistribution more likely.

Question 17

The face of the middle to late 20s is the standard in desirability of aesthetics.

Answer 17

T

Question 18

The overall shape of the young face is triangular, with the apex of the triangle occur at the forehead and the base at the zygoma.

Answer 18

F Apex at the mentum, base at the temples.

Question 19

The contours of the young face occur because of ampleness in the deep fat compartments.

Answer 19

T

Question 20

The face ages as a confluent mass.

Answer 20

F Individual fat compartments.

Question 21

In the ageing face, there is unbalancing of the face with areas corresponding to fat hypertrophy and/or fat atrophy.

Answer 21

T Causes hill and valley topography and abundance of shadows.

Question 22

The overall shape of the ageing face is triangular, with the apex of the triangle occurring at the mentum and the base at the temples.

Answer 22

F Apex at the level of the glabella, base at the jawline.

Question 23

In the ageing face , the temples become concave.

Answer 23

T

Question 24

In the ageing face, the lateral third of the face becomes concave.

Answer 24

T

Question 25

In the ageing face, the lower third of the face is arced on with a sweep of the jawline from ear to ear.

Answer 25

F This is true for the young face. Ageing face replaces the arc with an undulating curve.

Question 26

In the ageing face, the jaw has an anterior projection that then wraps inferiorly, forming an obtuse angle with the neck.

Answer 26

F This is true for the young face. Ageing face loses definition with respect to the neck.

Question 27

In the ageing face, cosmetic units flow.

Answer 27

F demarcated at underlying bony landmarks.

Question 28

A young nubile face is represented by fullness, arcs and many points of highlight.

Answer 28

T

Question 29

A patient’s weight does not affect the ageing face.

Answer 29

F

Question 30

Facial fat mirrors body fat.

Answer 30

T

Question 31

Patterns of facial fat atrophy and fat hypertrophy are changes that are relative to each other.

Answer 31

T

Question 32

In the young face, the facial fat is ‘balanced’ so that the face becomes rounded and homogeneously full.

Answer 32

T

Question 33

In the ageing face, weight can only be gained in patterns that correspond to hypertrophic areas.

Answer 33

T

Question 34

Only heavy ageing faces exhibit sagging as a direct result of fat redistribution.

Answer 34

F Also lean ageing faces.

Question 35

In the ageing face of a lean person, fat collects in the lower third of the face leading to jowls and prominent submental fat.

Answer 35

F Ageing face of a heavy person.

Question 36

Due to the loss of support from deep fat atrophy, a lean ageing face will collapse in the direction of gravity.

Answer 36

T

Question 37

A heavy ageing face will hold its shape regardless of the direction of gravitational pull.

Answer 37

F A young face

Question 38

Re-establishing the anterior projection of the cheek can serve to ‘lift’ the face forward and correct sagging

Answer 38

T

Question 39

There is an ‘optimal’ elasticity of skin, a point at which it is neither stretched nor deflated.

Answer 39

T This is seen in youth when the face is appropriately full of fat at ideal body weight.

Question 40

‘Elastic recoil’ is the point where the skin has the ability to ‘snap’ back to its original position when stretched.

Answer 40

T

Question 41

If an older person loses the subcutaneous fat layer, the overlying skin responds to the changes underneath by exhibiting ‘supercontraction’.

Answer 41

F This occurs in younger people.

Question 42

Photoageing is not responsible for the inelasticity of ageing skin.

Answer 42

F

Question 43

IPL, lasers, LN2, peels and retinoids can all be used for the poikilodermatous changes in the ageing face.

Answer 43

T

Question 44

Textural changes and fine wrinkles cannot be treated with IPL.

Answer 44

F

Question 45

Wrinkles at rest are best treated with botox.

Answer 45

F Wrinkles in motion.

Question 46

Wrinkles in motion are best treated with fractionated lasers and superficial fillers.

Answer 46

F Wrinkles at rest.

Question 47

Cosmetic improvement of the changes that occur with ageing must be specific to the structure or level of the skin in which the ageing occurred.

Answer 47

T

Question 48

Solar elastosis causing wrinkles with deep skin involutions is best treated with resurfacing methods.

Answer 48

F Resurfacing is best for superficial creases in the skin.

Question 49

Involutional changes of skin ageing (eg folds in the nasolabial area) are best treated with fillers. .

Answer 49

F Traditional rhytidectomy or structural augmentation

Question 50

Facial sagging is an atrophic event, occurring in the direction of gravity.

Answer 50

T

Question 51

In the treatment of the ageing face, care must be taken to reapproximate the shape and arcs of the young face.

Answer 51

T

Question 52

Structural facial rejuvenation is that which replaces the bone and soft tissue.

Answer 52

T

Question 53

Mid-face lifting procedures, synthetic and injectable implants and autologous fat transfer are all methods of structural facial rejuvenation.

Answer 53

T