Sally Woodbridge, Life Magazine October 1992 and 1944

Aging is not for the faint hearted, or for the skinny as it turns out. I don’t care how much junk you have in your trunk, as you age the volume goes down, not in your butt, but in your face. Who among us has not lost a few pounds and found out that the first place it shows is in the face, great if you are 25, not so great if you are 45. And If you start out skinny your face ages faster simply on the bases of loss of volume.

It’s not just that the fat goes south with age. The whole structure of the face changes including muscles that thin and bones that shrink. Oddly enough the only structure on the face that does not diminish with age is the skin! In fact it stretches and sags, need I say more.

Here is the challenge, retaining a youthful appearance. If we admit that we are losing the volume while the skin is stretching out we have two basic choices: add volume or take away skin. Traditionally the answer from the plastic surgeons has been “cut out the excess skin!” While that is appropriate at times it does not always give the desired result. No patient of mine has ever asked for the “wind tunnel” look, the tight pulled back hallmark of the aging socialite. My patients want to look great for their age and volume is part of the answer.

I feel like an artist with many colors in my paint box. Actually I guess I am more of a sculptor. I use fillers Juvederm, Restylane and Perlane) for instant results. Fillers are famous for making lips plump and softening the sharp edges of nasolabial folds and marionette lines. But the real teller of age is the hollow cheek, think “gaunt”. My favorite answer is Sculptra. I really love the way I can stimulate the patient’s own collagen to round out a concave cheek or temple. The process involves 3 or 4 visits over as many months. Gradual changes occur as the face grows younger, fantastic.

I don’t want to totally ignore the fact that the skin does loosen up. Once the volume is back though you would be amazed at how little tightening may be needed. For moderate skin tightening it is hard to beat Thermage. No downtime and no side effects and gradual firming.

Of course there is always the facelift but even the plastic surgeons are now admitting it is all about the volume.