Aging of the face
Download
1 / 48

Aging of the Face - PowerPoint PPT Presentation


  • 215 Views
  • Updated On :

Aging of the Face . ד"ר פרידמן טל כירורגיה פלסטית בי"ח אסף- הרופא. Aging of the Face. The process of facial aging represents a combination of gravitational effects and the aging of tissues. Gravity. Affects all tissue layers

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Aging of the Face' - peony


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Aging of the face l.jpg
Aging of the Face

ד"ר פרידמן טל

כירורגיה פלסטית

בי"ח אסף- הרופא


Aging of the face2 l.jpg
Aging of the Face

The process of facial aging represents a combination of gravitational effects and the aging of tissues.


Gravity l.jpg
Gravity

  • Affects all tissue layers

  • Results in: Brow ptosis, Hallow infraorbital region, Nasolabial folds, Jowls, Submental skin excess.


Pathogenesis of wrinkles l.jpg
Pathogenesis of wrinkles

  • Aging

  • Actinic damage

  • Genetic disorders


Aging l.jpg
Aging

A process of atrophy


Epidermis l.jpg
Epidermis

  • No change in epidermis thickness

  • Melanocytes 

  • Langerhans cells 

  • Dermal-epidermal junction


Dermis l.jpg
Dermis

Components of the dermal connective tissue layer:

  • Ground substance (Glycosaminoglycan gel + proteoglycans)

  • Elastic fibers (elastin + microfibrillar components(

  • Collagen ) Type I:III(


Slide8 l.jpg

General: 6% for a decade, Connective tissue matrix disorganized, avascular and acellular.

 Ground substance (GAG)

  • Elastic fibers  number and diameter

Collagen :Overall collagen content , III/I , Tensile strength of collagen fibril 


Skin appendages l.jpg
Skin appendages

  • Sebaceous glands  in size but sebum production 

  • Pacinian and Meissner’s corpuscles -  in number

  • Apocrine glands -  in secretion

  • Eccrine glands - 

  • Terminal hair follicles - 


Effects of age on skin l.jpg
Effects of Age on Skin

  • Thinning

  • Shearing forces

  • Elasticity

  • Immunologic changes

  • Increased susceptibility to UV light and cutaneous malignancies.


Actinic damage l.jpg
Actinic Damage

Pathognomonic: Dermal elastosis and epidermal dysplasia.


Epidermis12 l.jpg
Epidermis

  • Increase in thickness

  • Nuclear atypia of keratinocytes and monocytes


Dermis13 l.jpg
Dermis

  • Thickened degraded elastic fibers:

    “Basophilic degeneration”, “elastosis”: Degraded collagen and elastin.

  • Increase of ground substance.

  • Decrease of mature collagen (type I).


Inherited skin disorders l.jpg
Inherited Skin Disorders

  • Rare skin conditions that may present as premature skin laxity, or aging.


Ehlers danlos syndrom cutis hyperelastica l.jpg
Ehlers-Danlos Syndrom (Cutis Hyperelastica)

  • Histology: Abnormal collagen maturation and tissue fragility, increased capillary fragility.

  • Genetic defect: Lysyl oxidase

  • Clinical presentation: Hypermobile joints; Thin, friable, and hyperextensile skin; Subcutaneous hemorrhages; Ability to strech the skin- > Shrink back without wrinkling. Atrophic scars.

  • Rhytidectomy is not recommended


Cutis laxa l.jpg
Cutis Laxa

  • AD, AR, X-Linked

  • Inadequacy of elastic fibers through-out the body, especially in the skin, lungs and aorta.

  • 1' presenting symptom: extreme laxity prematurely aged.

  • AD: Involve only the dermis.

  • AR: Generalized abnoralities: Emphysema, pulmonary infection, cor pulmonale, and hernias.



Pseudoxanthoma elasticum l.jpg
Pseudoxanthoma Elasticum cardiorespiratory dis.

  • Mechanically stressed skin ( face and sides of neck and axilla) takes on the texture of plucked chicken skin.

  • Widespread artheriosclerosis- third decade.

  • Plastic surgery can be beneficial in the absence of vascular disease.


Progeria hutchinson gilford syndrome l.jpg
Progeria (Hutchinson-Gilford Syndrome) cardiorespiratory dis.

  • Inheritance: AR

  • Systemic dis.: Growth retardation, Craniofacial disproportion, Baldness, Pinched nose, Protruding ears, Micrognathia, Artheriosclerosis, Shortened life span.

  • No role for aesthetic surgery


Werner s syndrome adult progeria l.jpg
Werner cardiorespiratory dis.’s syndrome (Adult progeria)

  • Inheritance: AR

  • Scleroderma-like indurated patches of skin,

    Baldness, Aged facies, hypo-hyper-pigmentation

    Short suture, high-pitched voice, cataract, mild diabetes mellitus, muscle atrophy, osteoporosis, premature arteriosclerosis, neoplasms.

  • Elective surgical procedures are contraindicated.


Idiopathic skin laxity l.jpg
Idiopathic skin laxity cardiorespiratory dis.

  • Shelley, 1977, “ wrinkles due to idiopathic loss of mid-dermal elastic tissue”

  • Patchy areas of mid-dermal elastosis manifesting as localized fine wrinkling, without systemic abnormalities


Histology of the aged skin l.jpg
Histology of the aged skin cardiorespiratory dis.

  • Hashimoto, 1974- described 2 types of wrinkles in the skin:

    • Shallow wrinkle- sun protected area, disappears when the skin is stretched.

    • Deep wrinkle- sun-exposed skin, that does not disappear on stretching.


Slide24 l.jpg

  • Kligman- LM and EM: cardiorespiratory dis.

    • Cutaneous wrinkles are mechanically induced grooves of the skin in areas of frequent motion.

  • Tsuji- Histology of wrinkles:

    • Deep wrinkle- Greater amount of elastotic swelling on either side of the wrinkle than in the linear depression.


Slide25 l.jpg


Classification of facial wrinkles furrows and folds l.jpg
Classification of facial wrinkles, Furrows and Folds cardiorespiratory dis.

  • Wrinkles- Intrinsic aging and photoaging.

  • Clinical location: Cheeks, crow’s feet, perioral.

  • Tissue location: Cutaneous.

  • Treatment: Resurfacing.


Slide27 l.jpg

  • Folds cardiorespiratory dis.- The result of overlapping skin caused by genetic laxity, intrinsic aging, loss of tone, bony atrophy, gravity, and consequent sagging.

  • Clinical location: Lids, nasolabial fold, horisontal neck folds.

  • Tissue location: Muscular.

  • Treatment: Rhytidectomy,

  • Blepharoplasty.


Slide28 l.jpg

Furrows/ Lines: cardiorespiratory dis. Repeated facial expressions.

Clinical location: Forehead, Glabellar, smile lines.

Tissue location: Musculocutaneous.

Treatment: Muscle resection, Botulinum toxin, injectable skin filler materials.


Slide29 l.jpg

  • Combination cardiorespiratory dis. Combined approach.


Face lifting only addresses the effects of gravity l.jpg
Face lifting only addresses the effects of gravity cardiorespiratory dis.

It is not a treatment for fine wrinkles!!!


Stigmata of the aging face l.jpg
Stigmata of the aging face cardiorespiratory dis.

  • Skin: Intrinsic and extrinsic aging.

    Subcutaneous: Descent of facial fat-

    skin layer

    Fat: Gain or loss

    Retaining ll.-

  • Much of this change relates to a

    loss of support from the retaining ll., accompanied by dermal elastosis, and facial lipodystrophy.


Upper face l.jpg
Upper Face cardiorespiratory dis.

  • Drooping of the eyebrows.

  • Hooding of the upper eyelids.

  • Forehead wrinkling.

  • Glabellar frown lines.

  • Prominent lines and laxity

    of the outer canthus ,onto the

    temple area.

  • 40% of face- lifted patients

    have concomitant forehead

    lift (Owsley)


Middle and lower face l.jpg
Middle and Lower face cardiorespiratory dis.

  • Midface: Cutaneous descent superficial to the SMAS.

  • Lower cheek, and neck:

    Downward migration of the

    skin-fat-platysma layer.


Mid face l.jpg
Mid face cardiorespiratory dis.

  • Yousif- Analized changes in facial soft-tissues occuring with age :

    1994,5- Historical photographs and photogrammetry:





Skull l.jpg
Skull to the parasymphyseal area

  • Bartlett, Grossman and Whitaker,1992:

Analysis of 160 skulls:

Reduction of facial height,

Modest increase in facial width and depth and generalized coarsening of bony prominences.


Vectors of aging l.jpg
Vectors of aging to the parasymphyseal area

  • Alter the position and appearance of key anatomic structures:

  • The vector of aging of the cheek fat and platysma muscle in the lower face is inferomedial

  • The vector of the orbicularis oculi is inferolateral


Criteria for a youthful neck l.jpg
Criteria for a youthful neck to the parasymphyseal area

  • Inferior mandibular border

  • Subhyoid

  • Thyroid cartilage

  • SCM

  • SM-SM angle- 90 degrees.


The neck l.jpg
The Neck to the parasymphyseal area

  • Excess skin.

  • Excess submental fat.

  • Excess supraplatysmal or subplatysmal fat.

  • Platysmal bands.

  • Large submaxillary gland.

  • Micrognatia.


Slide46 l.jpg

  • Padgett and Stevenson, 1948- to the parasymphyseal areaPlatysmal bands:

    • The medial borders of the platysma m. tend to become redundant  Platysmal bands.

  • McKinney, 1995:

    • The bands are not the medial edge of the muscle, but rather lateral pleats caused by laxity of the muscle .

  • Pseudoherniation of the submental fat: “Turkey gobbler” deformity.


ad