Aging and aesthetic analysis Part 1
As in all living things, the aging of our skin and the related changes are inevitable, together with our body.
When the instinct of being chosen and admired is combined with the increasing social perception that beauty and youthful appearance determine success and attractiveness in business and social life, the desire to look flawless and young also increases.
Today, despite the advances in medicine and technology, it seems impossible to stop aging. However, with its rapidly increasing variety, anti-aging protocols, laser, medical aesthetic and surgical applications can provide excellent results for skin aging problems and patient expectations.
By dividing our skin into biological and social skin, we can better evaluate the aging process of the skin, aesthetic problems and patient expectations.
Our biological skin; All biological structural features such as cells and connective tissue are adversely affected by time and environmental factors and are in constant change. Changes in our biological skin, such as the appearance of wrinkles and sagging with aging, mostly occur in the physiological process. In these, there is no need for medical intervention other than aesthetic requests. However, aging and external factors also initiate pathological processes in the biological skin. Actinic keratosis, which develops with sun-induced skin aging, can turn into cancer over time. Although the person is not aesthetically disturbed by these, medical interventions and follow-ups are required.
Our social skin differs from our racial and personal characteristics that make us who we are. Although it can change according to our personal perceptions, time and cultural structure, it is the largest organ that determines our aesthetic perception of the body such as beauty and attractiveness. The aging and problem perception process of the social skin is directly affected by the biological skin. However, some determining criteria may vary according to the person, social perception and culture. In the biological aging process, a 50-year-old male patient accepts mid-forehead wrinkles as natural and even likes them, but unintentionally wants botox application on his forehead to get rid of them due to the increasing competitive conditions of his business life.
The signs of aging, which affect all layers of the skin, appear with internal and external factors.
One of the internal factors is our genetic structure. The aging process of each individual is determined by the genetic structure. (As we get older, we resemble our parents). Wrinkles caused by the facial muscles we use during gravity, mimics and facial expressions, wrinkles that occur during sleep, hormonal changes and general health problems are among other internal causes.
External factors can be summarized as sun and artificial light sources, smoking, air pollution, wind and cold air, and contact of chemical substances with our skin.
Changes that occur with intrinsic aging;
Disruption of the relationship between the cells that we call corneocytes that make up the skin
Thinning of the epidermis, which is the top layer of the skin, deterioration of the relationship between the epidermis and the dermis, which is the lower layer of the skin, and easy damage to the skin
Reduction of fibroblasts, which have many functions in the skin, especially tissue repair
Qualitative and quantitative negative changes of collagen and elastin from skin support tissues and accordingly the development of sagging and wrinkles on the skin.
Decreased subcutaneous fat tissue, muscles and even bone tissue in places. Accordingly, for example, the prominence of the temples and cheekbones of the face and the skeletonization of the face.
Accumulation of adipose tissue in undesirable areas; for example, accumulation of adipose tissue under the chin and in the food
Decreased functions of sebaceous glands and sweat glands that produce oil in the skin; causing dryness in the skin.
Reduction in hair follicles on the skin, but an increase in quince hairs, defined as vellus, in areas such as the nose
Graying of hair, beard and body hair
Thinning with weakening of the nails
Sebaceous glands that provide oil production in the skin in certain areas of the face; enlargement and coarsening of the cheeks, upper nose and chin
Changes that occur with extrinsic aging;
Freckling and development of spots (such as sunspots, seborrheic keratosis)
Development of regional discoloration areas on the skin
Development of coarser wrinkles on the skin with the development of elastosis
Increase in capillary structure
Formation of “venous lake” with small venous dilatations
Development of subcutaneous hemorrhages with the reduction of vascular support tissues in the skin
The growth of sebaceous glands, which produce oil in the skin, in certain areas, the enlargement of their ducts and the development of blackheads.
Pale, dull and lifeless appearance of the skin with decreased superficial blood flow and elastosis
During the aging process of the skin, changes occur in the connective tissue. These;
A thick material accumulates in the dermis sublayers with the change of elastin. The coarser elastin bonds are replaced by larger mass structures. This is called elastosis.
Collagen decreases and degeneration develops.
While hyaluronic acid decreases in the upper layers of the dermis, hyaluronic acid increases between these coarse elastin bonds in the lower layers of the dermis, which causes the skin to look harder and artificially with water retention.
Skin elastosis was classified by Fitzpatrick.
Type 1 mild elastosis; slight structural changes and slight striations in the skin
Type 2 moderate elastosis; there are prominent raised yellowish rashes on the skin.
Type 3 severe elastosis; Numerous yellowish raised structures are present. The skin appears pale and yellowish, with diamond-shaped wrinkles forming rhombuses on the skin.
Quantitative evaluation of facial soft tissues with aging; With aging, the volume of the facial supporting tissues decreases, the surface expands, and the supporting tissues are replaced by the effect of gravity. Reduction of skin support tissues on the face; It occurs with the reduction of dermis, subcutaneous muscles, and adipose tissue in the skin. This decrease causes tissue volume reduction. With the expansion of the skin surface, especially bags on the eyes, cheeks and neck, cause the development of sagging. Sometimes, these can become more visible with the accompanying tear gland or salivary glands. In the angled evaluation of the face, especially from the side, some convex structures are erased and flattening occurs in the cheeks and under the eyes.
Aging and skin quality are affected by internal and external factors. Internal factors are determined by genes and cannot be changed. External factors are factors such as sun, smoking, alcohol use, malnutrition. These can be protected.
Qualitative features of the skin are skin color, structure, tone, elasticity, pigmentation features.
Evaluation of dynamics of soft tissues; With soft tissue dynamics, we actually define facial muscles. Facial muscles are responsible for the appearance of facial dynamic lines and even facial folds.
Evaluation of supports of soft tissues on the face; As with facial bones, teeth and nose, cartilages are the supports of soft tissue. Their shapes and volumes affect how the person will age in the future, with the participation of the soft tissues they support in the aging process. The aging process depends on changes in these main structures.
Many dental-jawbone and facial bone problems (insufficient development of the middle bones of the face, lower jawbone development problems, angulation problems of milk and alder teeth, etc.) give an old appearance in young patients.
In young or middle-aged people, the elderly appearance may develop due to one or more factors. For example, the extension of the upper lip over time is affected by the structural length of the supporting tissue, the bone structure of the upper jaw, and the structure of the upper teeth. For example, in the patient below, the skin part of the upper lip appears longer than normal due to the short upper jaw. The upper lip is curved inward in profile. For this reason, the vermilion of the upper lip has even been erased. When evaluated with the E line in profile, the upper lip lags far behind and even the chin appears far ahead. The visibility of the patient’s anterior upper teeth and upper gums decreased while smiling. This gives the patient an older expression for his age.
When comparing a young face with an old face, we can see one or more of the following changes.
As the face ages, it starts to get longer and narrower. Its triangular appearance is reversed.
Some of the aesthetic parts of the face are lost and some parts become too obvious.
In the profile, the slopes on the face become flat when erasing.
Percentage new slopes appear.
Some anatomical structures are elongated in profile.
A simple assessment method that can be used to evaluate facial aging and signs
In the skin with aging;
Roughness of the skin to the touch
A scoring is made according to their degree and treatments are decided accordingly.
Deep wrinkles develop.
It is simpler to divide the facial region into sections as follows and to evaluate it in this way.
The area above the line passing through the eyes is defined as the “upper face”.
The area between the line on the junction line of the lips and the eyes is “Mid-face”. departmentis defined as ”.
The area between the junction line of the lips and the chin line departmentis defined as ”.
The area under this is “Neck upper departmentis defined as ”.
Evaluations are made in these areas and on the right and left.