The Upper Third of the Aging Face

A large percentage of patients requesting aesthetic improvement for an aging face almost surely will have some changes in the upper third of the face as well. Very seldom is aging a localized process affecting only one area. Aging occurs slowly and involves several parts of the face. Certain areas might show more deterioration than others. Unless there are significant signs of aging, many are not cognizant that changes of the forehead, eyebrows and temple areas are contributing factors to their aesthetic problems.

The upper face has many interrelated components, including the hair, forehead, glabellar area (the space between the eyebrows), the temple, eyebrows and eyes. It is important to understand how each of our features go together. Failure to recognize this might compromise the overall facial picture.

Ideally, the upper face of the male and female is comprised of thick scalp hair density with an irregular frontal hairline. The forehead is flat — (bearing no wrinkles) — and the temple is in an elevated position. The eyebrow is well positioned and conforms to the aesthetic parameters of the ideal eyebrow with good brow hair density. The patient’s sex is important; since the ideal male eyebrow is normally positioned at or slightly below the eyes orbital rim. The ideal female brow usually looks best situated slightly or moderately above the orbital rim.
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Some degree of forehead-glabellar wrinkling is acceptable for a male, but not as acceptable for the female. There is no bulging or drooping of the upper eyelids. The lower eyelid is flat with no fatty tissue protrusion. In addition, both the upper and lower lids should not show any evidence of loose, redundant skin.

While slightly more resistant than the lower face, the upper third of the face undergoes significant changes. As the aging process commences, changes in the face are inevitable for all. Changes that occur in the skin’s texture are mainly due to decreased activity of the sebaceous glands. It is recognized that gradual loss of the skin’s elasticity creates loose and damaged skin.

Wrinkles begin to develop; since the skin loses some of its ability to contract back to its original condition. This laxity can create deep horizontal and/or vertical wrinkles of the forehead, in addition to significant drooping of the eyebrows and upper eyelids.

These contributing factors, along with three groups of muscles, are responsible for negative expression to the face. The frontalis muscle elevates the eyebrows and is responsible for horizontal wrinkles. Two corrugators pull the medial end of the eyebrow toward the glabellar region (area between the eyebrows) resulting in vertical frown lines, and the procerus elevates the top of the nose producing horizontal lines in the frontonasal groove. As a result of surgically elevating and manipulating these muscles, there undoubtedly will be a change in expression. This, of course, is the surgical objective.

At first, the signs of aging seem quite insignificant. As time goes on, these manifestations become more pronounced. Even with careful makeup application, or a camouflaging hairstyle, it becomes increasingly difficult to conceal or disguise them. Gradual loss of attractiveness or a youthful appearance can become a deep emotional concern.

Many aging men and women find they look older than they actually are and feel. Many of these people are physically healthy and energetic with lively personalities. Their lives are filled with activities and most of all they have a genuine positive attitude. In contrast to this vitality, they appear tired, unhappy, annoyed, ill and even neglectful in their appearance. Cosmetic surgery should not change the personality. The aim is to help remove the stigma of a false personality to a truer picture of their inner-self. Facial cosmetic surgery is one way to attempt to rejuvenate what nature has given, but time has taken away.

Everyone has their own unique characteristics. Any operation aiming to produce an aesthetically pleasing effect must, therefore, be evaluated and performed in a different way. Before the appropriate surgical maneuver is implemented, many variables must be taken into consideration. To produce better and longer lasting results, many ingenious procedures are available, including: The Direct Eyebrow approach, Coronal Forehead Lift, Pretrichial, Mid–Forehead, Endoscopic Forehead/Eyebrow lift, and the Temporal Lift.

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