What do we subconsciously look at, besides wrinkles, that makes us instinctively know that someone is of a certain age?
Your brain loves to classify things and there are lots of things that clue our brain in to an approximate age of a person we are looking at.
A few subtleties, from the top, down, excluding wrinkles:
Thinning hair/receding hairline - This generally doesnât happen until later in life so is typically a sign of aging. PRP treatment is already showing promising results in treating this condition.
Sunken temples - no one comes into the clinic exclaiming, âMy temples have sunken!â But I know that if there is a concavity to the temples, the person looks older. Fill in the temples (using a filler like Radiesse), and in a subtle, yet obvious way, the patient typically agrees they look younger yet wouldnât be able to put their finger on the reason if they didnât know.
Hooded eyelids - although many people (myself included) have low-riding brows, excess skin on the upper lids gives away age.
Under-eye bags - these can come in the form of a tear trough, or depression from the inner corners of the eye diagonally downward about an inch; or they can be full-blown herniated fat pads. The former can be treated with filler (I prefer Belotero for this) and the latter must be corrected by surgical intervention.
Flattened cheeks (as fat pads fall forward)Â - This happens to 100% of people. If there is one thing a person needs first, filler-wise, it is almost universally cheeks that need restoring. Typically we notice that a personâs cheeks, usually right as a continuation of the tear trough mentioned earlier, start to flatten and the weight of the cheek dips below the line of the nose at the bottom. When we see this, it is obvious a person needs cheek restoration.
Smile lines from the corners of the nose to the corners of the mouth (nasolabial lines)Â - This is often corrected by treating the cheeks. At the very least, it is made better by correcting the cheeks and sometimes I save a little bit for this area itself. In my opinion, if you go to a place and the practitioner sees a line and wants to fill the line, you will not get the best, most natural result. I like to ask where this line comes from. It comes from the cheek falling, so if you just fill the line and still have the cheek falling forward onto it, it wonât look natural. Naturally, the cheek is up, holding everything up when there arenât nasolabial folds to be seen, so it only makes sense that if we put things back to where they used to be, it will look natural, because those structures used to naturally be there.
Downward turn of mouth corners - Often I see patients who have had prior filler procedures, yet the provider did not correct the downward turning lip corners. This is an injustice, in my opinion. The mouth makes up a third of the area of the things on the face, so if the corners turn downward, the person is going to look like they are worried or upset, unless of course, they are able to walk around with a full smile on their face the entire day. Anything pointed downward must be corrected if the goal is a more youthful look, whether it is glabellar lines, tear troughs, the break in the cheeks, or the downward turning of the mouth corners (or âmarionette linesâ as they are sometimes called, after the puppets that can open and close their mouths when the puppeteer commands).
Jowls - Certainly this is universally a sign of aging. There used to only be surgical fixes for this, but nowadays we have a couple of nonsurgical options. If it is mild, we can often use fillers (like Juvederm Voluma or Revanesse Versa) placed in front of the jowls to reduce their appearance. If it is more moderate in severity, we now have PDO threads, which are pretty great in the right hands. PDO threads are textured, absorbable suture material that has been around for over 30 years, often used in heart surgeries. They are placed right under the skin, so they are less invasive than Botox or fillers, which are placed in the muscle and sometimes right over bone, respectively. One day someone had an idea, âwhat if we stick these in the face?â and in this case, it turned out to be a good idea. And so the PDO movement was born.
Vertical neck bands - These generally only exist in people who display signs of aging. Often they can be corrected by the neuromodulators Botox/Dysport/Xeomin/Jeuveau as they usually originate from a unique muscle called the platysma muscle. The platysma is the only muscle that is integrated within the skin and other muscles and doesnât cause movement by directly connecting two bones. You are using your platysma when you draw out the corners of the mouth to the side and downward. Vertical bands are often easily treated with neuromodulators.
Those are most of the rest of the signs of aging on the face besides wrinkles. Personally, I think itâs the structural things that give it away the most - cheeks, temples, downward turning lip corners.