With the life expectancy of the average American increasing and the age of retirement creeping towards 70, it is not difficult to understand why more and more individuals are seeking cosmetic surgery to eliminate the signs of aging. The onset of aging plays an important role in the welfare of many men and women. Most individuals feel vigorous and energetic and thus, younger than they look. Looking older than you feel can have a tremendous psychological effect. In fact, it may have both a social and economic impact as well. Almost everyone knows of someone who has been limited in their ascent of the corporate ladder because they “look old and washed out”, in spite of the fact that they are often more capable and competent than younger individuals.

Today, many people are consulting facial plastic surgeons to help in eliminating the tell-tale signs of aging when they first appear. Those same individuals are pursuing a continual maintenance program of minor surgical procedures. These individuals never seem to age or grow older in comparison to their contemporaries. This is the ideal situation for many people, and the approach many celebrities have chosen to follow.

Aging Process of the Face and Neck

The aging process begins in the mid-to-late twenties and involves several components of the face.

One must take into consideration the changes that occur in the skin, fat, muscles, and bones. With time and age, the facial muscles and fatty deposits become thinner and smaller, and subsequently cause the overlying tissue to shift to the facial and neck areas. This occurrence, along with the simultaneous loss of elastic tissue, results in the deep and increasing lines of the face, as well as the sags and bags brought on by the relentless pull of gravity. Deepening lines around the corners of the mouth and across the forehead, and the sagging of the outer eyebrows and jawline are all a part of the aging process. In addition, degenerative changes occur in the outer layer of the skin so that it becomes etched with wrinkles.

One of the more obvious portions of the face where the aging process seems to be particularly noticeable is around the eyes. The tissues around the eye become so weak that fat, which is contained in the tissue, herniates through the tissue, producing the commonly visible bags and pouches that produce the “tired look”.

As time goes on, fine lines radiate onto the lips, especially in women. As this process continues, the corners of the mouth fall and the sagging skin below the ear causes the earlobes to elongate. Finally, the tip of the nose droops, causing it to appear larger and longer. Repositioning the tip of the nose with a nose life can have a dramatic and lasting rejuvenating effect on the face.

Each individual presents a different problem (or problems) and consequently, the procedures required to correct the signs of aging vary. Several factors which influence the pace of the aging process include heredity, stress, smoking, and exposure to the elements. Excessive exposure to sunlight expedites the aging process and the deterioration of the upper layer of skin. One person may require an eyebrow lift, another correction of a double chin, and for yet another, a facelift may be in order. Finally, when the skin is weather beaten in appearance, it cannot be improved unless a chemical face peel is completed. While a chemical peel does not improve the sagging face, it does alleviate the wrinkling.

From Fedok FG: The Aging Face. Facial Plast Surg 12(2):107-115, 1996.

When is Facial Surgery Indicated? How Long Will it Last?

The signs of aging do not follow a strictly defined timetable; therefore, “when?” is a frequently asked question. It seems the best answer to “when?” is when the sagging of the face and neck, and bagginess of the eyes is more than a temporary condition relieved by rest or concealed with cosmetics. A person’s age offers no particular restrictions for people considering facial plastic surgery to correct the signs of aging. Patients in their seventies or even eighties may be good candidates for surgery, it they are in good mental and physical condition.

“How long can I expect the results to last?” is the second-most frequently asked question. The effects of the surgery actually last forever, but the aging process will continue. There is also a component of rebound relaxation of the tissues that causes a minor degree of recurrent relaxation of the facial tissues. No operation can permanently prevent aging, but the individual who has surgery never appears as old as he or she would without the surgery.

To better understand this, one can think of a conveyor belt of time. Time moves along at a steady pace, and so does the aging process. Surgery might move a patient’s appearance back several years so they might appear as they did five to ten years prior to completing surgery. Time and the conveyor belt will advance to eventually return the patient somewhat back to their initial pre-surgery position. However, the individual may still appear five to ten years younger than their chronological age. Although, it is not necessary, some individuals will continue to complete minor surgeries – a preventive maintenance program, if you will – to maintain the youthful look.



Not every patient seeking facial plastic surgery for aging is an acceptable candidate for one reason or another. I do not recommend surgery for individuals who have a serious medical condition or are in the midst of an emotional crisis. Nor do I recommend surgery for those patients who have unrealistic expectations or improper motivations for this surgery. In addition, patients who refuse to accept my recommendations about the type of surgery needed are not good candidates.

Incisions and Scars

It should be clearly understood that all surgery begins with an incision and must heal with a scar. This is true of any incisional surgery. The incisions and resulting scars are usually hidden in the hair or placed in the natural facial folds, the junction of the ear and face or the nose and face, so they eventually become more inconspicuous. Hair styling and cosmetics can satisfactorily camouflage scars as they become mature following surgery. Healing varies from one patient to the next, and some patients are prone to developing thicker scars than others.

Swelling and Discoloration

Following surgery, patients must be willing to accept the temporary swelling and discoloration which occurs. Although this may be a disconcerting experience, it is not painful and may be a minor inconvenience compared to the physical and psychological benefits which result.


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