Periorbital, lower face, and neck

Abstract

Facial ageing occurs as a consequence of multifactorial changes in both the external skin and underlying tissues. The ageing process may vary dramatically between individual patients and is thus influenced by genetic factors. When assessing the ageing face it is important to consider the skeletal architecture, the soft tissue layers including the anterior fat pads, the osseocutaneous ligament anchors, and finally the overlying skin. Assessment of the external skin incorporates factors such as dermal thinning, solar damage, lifestyle effects such as smoking, and Fitzpatrick skin type. Surgical correction of facial ageing attempts to reverse both gravitational change of soft tissues and also to restore volume loss. There are a variety of methods used to divide the face into regions, but for the purpose of this chapter, the surgical management of facial ageing will be separated into three anatomical areas: (1) upper face, including the upper eyelids, eyebrows, and forehead; (2) midface, including the lower eyelid/anterior cheek continuum; and (3) lower and lateral cheek, neck, and perioral region