Over the past 20 years, the demand for cosmetic procedures among our ageing population has evolved, and there has been an increasing demand for patients to seek less invasive procedures for facial rejuvenation. The improvements in knowledge and techniques, and the introduction of longer-lasting soft tissue fillers have led to an increased acceptance of cosmetic treatments. More patients are looking for less invasive procedures over surgical treatments. Platelet-rich plasma (PRP) is an autologous concentration of human platelets in a small volume of plasma. It is a safe treatment and, thanks to the included growth factors, may represent the perfect option for a large number of procedures.
The demands of our ageing population have evolved substantially over the past few decades, with patients from the ‘baby boom’ generation now well into their 60s and demanding to look as young and as healthy as possible. These requirements have been coupled with the desire of the majority of patients to seek less invasive procedures for facial rejuvenation.
The improvements in our knowledge and techniques, and the introduction of longer-lasting soft tissue fillers, have led to an increased acceptance of cosmetic treatments in society as a whole. A greater number of patients are now looking for less invasive procedures over surgical treatments. However, Sclafani1 argues that ‘the ideal soft tissue filler has not yet been found, one which seamlessly integrates into the surrounding tissues, is easy to place, inexpensive, readily available and persistent. Currently available soft tissue fillers may be degraded, elicit a foreign body response with encapsulation and can be quite expensive’.
It is now known that the facial ageing process is not only a result of gravity, the disappearance of the malar fat pad, and/or lack of collagen, but is a complex puzzle involving a variety of facial elements, which occurs as a cascade effect. This process affects the four main facial layers—bone, muscle, fat and skin—the changes of which fall in two directions simultaneously, from the outside skin layer inward towards the bone, and also from the bone outwards towards the skin. Any modification in one layer will affect the next to progressively impact the effects of ageing.
The most significant change in the first layer, the bony facial skeleton, occurs in the facial apertures. The nose and orbits actually increase in size with age, by as much as 20%; the eye sockets largen over time and the infraorbital bone, just under the eye, moves backwards. Consequently, all other structures (muscle, fat and skin tissues) begin to descend and slip from the surface of the receding bone. Gravity is partly the cause of this effect, but in combination with the changes to the facial skeleton.
Contrary to popular belief, the facial muscles actually tighten with age, not loosen. This can be seen in the platysmal bands of the neck, which stretch from the chin to the clavicle and become more pronounced with age, similar to the appearance of crow’s feet and deep-set glabella lines. At the same time, the amount of fat present in the facial fat pads decreases with age and causes a gaunt appearance, resulting not only in volume-loss, but also a lack of efficient hydrating and elastic functions. The fibroblast cells producing elastin, collagen and hyaluronic acid (HA) work best when they’re under a degree of stretch. A lessened volume of fat and stretch results in poorer skin functions and the resulting sagging effect.
Ultimately, the process of facial ageing is a complex cascade in which each facial element affects and interacts with the other.