Facial Rejuvenation: A Regional Assessment

Facial volume loss as a result of aging can be partially attributed to bone resorption and cartilage remodeling, although certain areas of the face undergo fat redistribution. The underlying anatomic structure of the face allows the signs of aging to be regionally assigned to the upper, mid, or lower face. Aging in the upper face, ascending from the zygoma and including the orbits, is characterized by horizontal hyperkinetic rhytides on the forehead, glabellar wrinkles, and lateral canthal rhytides, with occasional lipoatrophy in the temple and periorbital regions. The use of botulinum toxin type A and hyaluronic acid products is common in upper-face rejuvenation. Nasolabial folds and volume loss in the preauricular, malar, and buccal regions are common targets for facial rejuvenation in the mid face, descending from the zygoma to the oral commissure. Liquid silicone, autologous fat, calcium hydroxylapatite, and poly-L-lactic acid are injectable products that can be used to correct the appearance of lipoatrophy and volume loss in the mid face. The perioral region and the area inferior to the oral commissure are described as the lower face. Resurfacing techniques, collagen hyaluronic acid fillers, as well as poly-L-lactic acid and polymethylmethacrylate beads are useful in these areas. Lips should be treated only with collagen and hyaluronic acid supplemented by resurfacing procedures. Complete facial treatment requires multiple approaches; each must be sensitive to the needs of the patient and to the area requiring treatment. This review will discuss the regional categorization of the aging face and rejuvenation options currently available.