HOW WE AGE
For humans our face has always been the focus when it comes to the process of the enhancing of features, be it simply with make-up or more dramatically surgical intervention. Over time our knowledge and understanding of the facial anatomy & the way skin ages have enabled us to successfully treat ageing concerns more effectively. There has been a major progression over the last 2 decades & advances in clinical interventions have enabled us to treat the root causes of ageing before it happens or even reverse premature & accelerated ageing.
When considering the anatomy of the face for rejuvenation with injectables, it is helpful to think of it in its entirety as a three-dimensional structure that consists of five unique layers running superficial to deep. This is important so that we know which structures we are aiming to treat & the success we will gain from each approach.
We must remember, that the ageing process affects not only the most visible part of our face, the skin but also other intrinsic factors that are at play including deep fat layer loss as well as loss of muscle laxity & ligament and bone deterioration dramatically accelerating ageing.
The first layer, the outermost layer of the face is the skin, which comprises both the epidermis and dermis. Beneath this, you will find the subcutaneous layer that comprises of fatty tissue. The subcutaneous layer sits on top of the fascial layer which varies depending on the area of the face. For example, in the forehead the fascial layer contains the frontalis muscle, the temporal region contains the temporal-parietal fascia and below the zygoma in the mid and lower, the fascia becomes the SMAS (superficial muscular aponeurotic system) which is fibro-fatty and lymphatic fascial tissue that contains the muscles for facial expressions.
Underneath the SMAS layer is a layer that has traditionally been considered to be a loose areola tissue layer. We now understand that this deeper layer comprises of multiple discrete fat compartments and can be sometimes referred to as the deep fat layer. Beneath this is the periosteum of the facial skeleton.