Aging and aesthetic analysis Part 1
As in all living things, aging of our skin and related changes are inevitable, together with our body.
When the instinct of being chosen and admired, success and attractiveness in business and social life are combined with the increasing social perception in the direction determined by pleasantness and youthful appearance, the desire to look perfect and young also increases.
Today, despite the advances in medicine and technology, it seems impossible to stop aging. However, with its rapidly increasing diversity, anti-aging protocols, laser, medical aesthetic and surgical applications can provide perfect results for skin aging problems and patient expectations.
By dividing our skin into two as biological and social skin, we can evaluate the aging process of the skin, aesthetic problems and patient expectations more adequately.
Our biological skin; cells, connective tissue, with all their biological structural features, are adversely affected by time and environmental factors and are always in 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 our largest organ that determines our aesthetic perception of the body, such as pleasantness 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 individual, 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 in order 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 look like our parents). Gravity, facial expressions and wrinkles caused by the facial muscles we use during our words, wrinkles that occur during sleep, hormonal changes and general health problems are in the middle of 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 issues with our skin.
Changes that occur with intrinsic aging;
Disruption of the bond between the cells that we call corneocytes that make up the skin
Thinning of the epidermis, which is the uppermost layer of the skin, and the deterioration of the connection 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 the underlying tissues of the skin and the development of sagging and wrinkles in the skin accordingly.
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, which provide oil production in the skin; causing dryness in the skin.
A decrease in hair follicles in 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, which 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
The development of subcutaneous hemorrhages with the reduction of vascular reinforcement tissues in the skin
The growth of sebaceous glands, which provide oil production in the skin, in certain areas, the expansion of their channels and the development of blackheads.
Pale, dull and lifeless appearance of the skin with decreased superficial blood flow and elastosis
In 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 in the middle of 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 clearly 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 facial reinforcement tissues decreases, the surface expands, and the reinforcement tissues are replaced by the effect of gravity. Reduction of skin abutment 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 eye, cheeks and length bags cause the development of sagging. Sometimes, these can become more visible with the accompanying tear gland or salivary glands. In the angular 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 sun, smoking, alcohol use, bad diet. These can be protected.
The qualitative characteristics of the skin are in the form of skin color, structure, tone, elasticity and pigmentation.
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 the abutments of facial soft tissues; As with facial bones, teeth and nose, cartilages are reinforcements of soft tissue. Their states 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 individuals, the aged 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 reinforcement tissue it has, 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 usual 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 a more aged expression than their 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 begins to lengthen and narrow. On the contrary, its triangular appearance turns.
Some of the aesthetic parts of the face disappear 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.
An easy estimation 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 easier to divide the face region into parts as follows and to evaluate it in this form.
The area above the border passing through the eyes is defined as the “upper face”.
The line on the junction of the lips and the area in the middle of the eyes is defined as the “middle part of the face”.
The area between the junction line of the lips and the jaw line is defined as the “Face subdivision”.
The area under this is defined as the “upper neck part”.
Evaluations are made in these areas and on the right and left.