An increasing number of patients are requesting less aggressive treatments to improve their facial appearance. The technical skills and range of new material available have made it possible to shift towards the liquid facelift, which comprises a combination of non-permanent dermal fillers with neurotoxins. This articles explores the surgical techniques available, and compares the pros and cons of the medical treatment, highlighting the potential results and the lower rate of complications when opting for the liquid facelift.
The surgical approach to the correction of facial ageing has changed dramatically over the last few decades. This has largely been the result of social changes with regard to populations desiring intervention for the inevitable ageing of their appearance. Equally important has been the development of technologies and techniques directed at accomplishing this intervention. Currently, a range of injectable methods have gained wide acceptance. These methods include the use of botulinum toxin and injectable filler substances1.
There is no doubt that classic surgical and non-surgical procedures such as blepharoplasty, rhytidectomy, or laser resurfacing still represent important techniques in aesthetic and facial rejuvenation. It is also clear that the combination of these traditional treatments with other procedures that offer improved skin quality and texture, wrinkle appearance, are low risk, cost-effective, carry low morbidity, and quick recovery, represent important advancements. Different types of dermal fillers or soft tissue augmentation combined with botulinum toxin (e.g. Botox; Allergan, Irvine, CA.) injection represent an important non-surgical resource that, combined with traditional techniques, can improve or extend the results.
The ageing face can be distinguished in a number of ways from a more youthful appearance, reflecting the interplay of extrinsic and intrinsic factors. Important extrinsic factors include the varied consequences of photodamage, cigarette smoking, alcohol consumption, diet, and general health. Intrinsic factors encompass gravitation effects resulting from decreased skin elasticity, loss of volume in the facial fat compartments, and bony and soft tissue remodelling. Additionally, the repetitive actions of the muscles of facial expression exert profound changes on the skin’s appearance, known as hyperdynamic wrinkles and folds, which eventually become permanent static changes2. Ageing is a complex process involving two important factors3:
Facial volume loss
Repetitive muscle movements that cause wrinkles and folds.
The basics of facial beauty are symmetry, balance, and proportion. The most significant forces responsible for facial ageing include gravity, soft tissue maturation, skeletal remodelling, muscular facial activity, and photodamage. Ageing in the upper third of the face manifests as rhytides and ptosis of the frontal, glabellar, and brow regions. Beginning in the mid-to-late-30s, facial ageing becomes more apparent. Wrinkles and fine lines appear around the eyes and mouth, and the upper and lower eyelids begin to sag. As age advances, through to the 50s and 60s, the jaw line begins to sag, the neck skin drops and develops folds, and the tip of the nose begins to drop.
Facial ageing is a complex process, and it is unlikely that one single procedure or product will resolve all issues for all patients. Over time, there is a loss of volume throughout the face. The movements of muscles weaken the facial areas, causing wrinkles and folds2.