Content provided by Cleveland Clinic.

What is facial aging, and what causes it?

Facial aging refers to how the appearance of your face changes with age. Facial aging occurs mainly as the result of (1) skin changes and (2) changes in the deeper soft tissues of the face. Factors that influence external skin changes include natural aging, skin type, sun exposure, facial movement and routine skin care. Facial fat deeper within the face thins with normal aging and, as gravity pulls on the face, the underlying soft tissues droop. These two types of changes are separate processes and require different treatments.

What kind of skin changes occur with aging?

As the skin ages, it loses its elasticity and skin tone, which eventually leads to fine and coarse wrinkles. The surface of the skin might become rough and dry. The outer layer thins, which gives the skin a translucent appearance and might reveal small underlying blood vessels. Sun exposure causes freckles and abnormal facial pigmentation (skin coloring), as well as pre-cancerous and cancerous skin lesions. These are the changes that can be improved with chemical peels, dermabrasion, and laser resurfacing.

What kind of gravitational changes occur?

Gravity causes stretching and looseness (laxity) in the supporting ligaments (flexible bands of tissues) of the face. As a result, the forehead and eyebrows droop, and folds of skin develop on the eyelid. Fat in the cheeks also droops, which results in deepening of the smile lines and the formation of jowls. The neck begins to sag and develops neck bands.

These changes cannot be corrected with chemical peels, dermabrasion or laser therapy, but require procedures such as a face lift, neck lift, forehead lift or eyelid surgery to re-drape the skin and re-elevate the underlying deep structures.

What kind of daily skin care should I be using to fight facial aging?

Healthy skin starts with prevention. Daily skin care should include skin cleansers, moisturizers, and especially sunscreens to prevent accelerated aging of the skin. Daily skin care programs are also available to help enhance sun-damaged skin. These programs might include cleansers or lotions containing alpha hydroxy acids, such as glycolic or lactic acid.

Bleaching agents such as hydroquinone (Eldoquin Forte, Melanex, Solaquin) and kojic acid might also benefit patients with mild pigmentation abnormalities. Many patients can benefit from tretinoin (Retin-A), which increases the thickness and health of the skin. Other products available include salicylic acids and vitamin C solutions or cream.

Many factors determine which combination of skin care products is right for you. Consultation with a plastic surgeon trained in skin care can help you develop the correct approach for your skin care needs.

How do skin resurfacing treatments work?

Skin treatments such as chemical peels, dermabrasion, and laser resurfacing improve skin tone and pigmentation by removing the sun-damaged outer layers of the skin. As the surface heals, a thicker and healthier outer skin layer (epidermis) develops, and new collagen (skin protein) forms in the deeper skin layers (dermis). Essentially, the skin takes on characteristics of younger skin, including improved texture and tone, and the elimination of or improvement in facial wrinkles and abnormal pigmentation.

Which treatment is right for me?

Many factors will influence which procedure is right for you, including:

  • The location and the type of abnormal skin changes
  • The degree of sun damage
  • Your natural skin type (color)
  • Your expectations
  • The amount of recovery time required

A consultation with a plastic surgeon can help you identify your concerns and skin care needs. Mild skin changes common with facial aging and sun damage require light- or medium-depth peels. Moderate changes should be treated with a medium-depth peel, dermabrasion or laser resurfacing. Severe skin changes require a deep chemical peel, dermabrasion or deeper laser resurfacing.