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The Aging Face (Part 2): Middle Face

In this three-part series, Dr. Lucero helps us understand facial aging, by identifying the typical signs of aging on the lower, middle, and upper areas of the face, their causes, and the various ways by which we can address each of them to achieve the most comprehensive and natural-looking results.

Previously, we discussed lower face aging. Today, we move on to the midface.

One of the key concerns that plastic surgeons address when it comes to facial aging among patients is volume loss.

Perhaps, more than any other part of the face, this is particularly true for the middle area, which is composed of the lower eyelids, the cheeks, and the nose.

For this key facial component, a youthful look largely depends on the presence and even distribution of sufficient amounts of fat underneath the skin, which gives the face its smooth contour, and allows it to properly reflect light for a glowing and vibrant look.

As a result of the confluence between multiple natural processes (ie. loss of skin elasticity, fat and muscle atrophy, loss of bone density, and bone recession) and environmental factors such as sun exposure, gravity and personal lifestyle, the midface loses its ideal shape and volume.

The cheeks shift downward, making them look limp and lose their natural glow. Meanwhile, the lower eyelids droop and dark circles around it begin to form because of the presence of eye bags, tear troughs and deep grooves. Aggravating the situation further is the appearance of deep lines (nasolabial folds or laugh lines) between the sides of the nose and the cheeks, due to years of facial contraction. The end result? Overall bagginess that makes one appear weary and sad.

All these may seem like a nightmare for those who are conscious of the way they look. Luckily, with an open mind, an overall healthy condition and reasonable expectations, there is a way to get around these problems.

As mentioned in the previous article, addressing the signs of aging through a comprehensive approach is the key to a successful facial rejuvenation. A crucial part of this approach is treating the signs of aging on the midface, which is a focal point of one’s face. After all, smoothing out wrinkles on the upper face, and/or lifting saggy areas on the lower part would be for nothing if the problems on the most prominent part of the face are not taken care of.

For the middle part of the face, various techniques exist to reverse or minimize the visible signs of aging and somehow restore the ogee curve*.

Injectables like derma fillers can be used to fill up deep grooves and smooth out lines, while multiple injection techniques such as the 8-point lift can take care of the precursory signs of sagginess on the cheeks.

Non-invasive treatments like Ultherapy, which uses ultrasound to trigger collagen production and subtly lift saggy skin can also be performed for mild to moderate cases of facial sagging.

Finally, for more severe cases, a surgical approach would be most helpful, as in a facelift for advanced facial sagginess, or an eye bag removal procedure for the lower eyelids. In particular, a fairly novel technique called the deep-plane facelift is best-suited for the midface, as its approach of treating aged skin on a layer deeper than that involved in traditional facelifts allows for the most palpable yet natural-looking results.

Again, it cannot be overemphasized that the way to go about treating midfacial aging, as in the case of lower face aging, is not simply to choose any one, some or all of these procedures. A good and reliable surgeon knows this, and it is important that one be patient and selective enough to have procedures done by such surgeon, who should understand exactly what the patients needs and what has to be done to deliver the best results. The expertise and experience of the surgeon who will perform the procedure is just as important as the nature of the procedure itself.

Remember, quality is a necessity and not a mere luxury, so take no chances and consult with a trustworthy surgeon to discuss a thorough treatment plan that would best suit your case.

To wrap up the discussion on facial aging, we tackle the upper face next…

*Arch formed by Two S-shaped curves meeting at a point. In facial anatomy, it is characterized by prominent cheekbones smoothly flowing into the mid-cheek hollows.

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