As an aesthetic plastic surgeon in Charlotte, I believe there are 3 buckets or events that occur that are responsible for the aging process. A youthful face has smooth transitions from one area of the face to another, and the skin is clear, bright, and vibrant. Aged skin has poor skin texture, quality, and uneven coloring. An aged face loses the smooth concave transitions to the face. Hallows, valleys, and wrinkles formed during the aging process create shadowing and darkness on the face. This contributes to a tired appearance. I believe there are 3 buckets that we must continually work on to keep full in order to age gracefully are:
1) Damage to the skin
2) Descent of tissue
3) Deflation or loss of volume in the face
Every day the skin on our face is exposed to the damaging effects of the sun. The ultraviolent light breaks down collagen and causes the skin to form freckles and other pigmentary changes. Proper care of the skin is vital in maintaining a youthful appearance and it does not take much effort. When a proper plan to protect, restore, and repair the skin in in place, patients can appreciate the difference healthy skin adds to their facial appearance. Poorly maintained skin will limit any additional facial procedures to improve facial harmony.
Years of gravity and the loss of elastic tissue in the face will cause the tissue of the face to descent or sag overtime. The skin loses its ability to stay tight on the tissue underneath. This descent is also due to the third bucket point, volume loss of the face. A good way to view the effect of the loss of volume on the face is to view the face as a balloon that is slowly releasing a small amount of air. At first, the balloon looks fine, but overtime it begins to form creases (wrinkles) and sag. In the face, we lose both fat and bone as we age.

The good news is that there are plenty of options to improve your skin and appearance. First, I would recommend using medical grade skin care products to improve the appearance of the skin. To correct the descent or deflation of the skin, a facial plastic surgeon has many tools that can improve the appearance of the face. Volume can be added both surgically (fat grafting to the face) and non- surgically (facial fillers and collagen stimulators). Adding volume will also help raise descended tissues. Patients with more advanced stages of aging, there are surgical procedures to improve sagging skin of the face. For sagging skin around the eyes, a patient can have the excess skin removed, blepharoplasty, or have the lower face lifted with a facelift or necklift.
We all age uniquely and at different rates. The key to getting the best outcome is to find a good aesthetic surgeon or doctor to create a treatment plan that will help you age gracefully. In a world surrounded by “extreme makeovers”, patients are better served doing a variety of small steps over time to help them age elegantly.