Rejuvenating The Upper Face--Things CAN Look Up

Dr. Nelson Lee Novick Dermatologist New York, NY

Nelson Lee Novick, M.D. is a Clinical Professor of Dermatology at Mount Sinai School of Medicine in New York City, an Attending Physician, and a former OPD Clinic Chief within the department of dermatology of the Medical Center. He is board-certified both in internal medicine and dermatology and is a Fellow of the American... more

Up to now, I've discussed the use of robust, injectable volumizing and lifting fillers for framing the face by treating the temples, as well as the rear angles of the jaw and chin. I  also emphasized that it is no longer considered de rigeur to jump right into treating smile lines or sad lines without addressing the underlying volume loss issues in the cheeks and elsewhere that contributes to them. And we have covered the importance and centrality of the eyes to how we are perceived and how old we are judged to be. So, that takes care of the main issues of the lower two-thirds of the face.

But what about the upper third of the face, from the eyebrows across the forehead and up to the hairline. I am going to leave for a future post how we can deal with the muscles of facial expression that contribute to so much to age-related changes not only to the upper third of the face but to the entire face (and neck, as well). Right now, we are going to concentrate on volume loss and its impact on the upper one-third of our faces. Loss of supportive fat tissue in the region of the outer one-third of the eyebrows with aging (especially when coupled with age-related shrinkage of the temple fat compartments, which was discussed in a previous blog post) leads to a sinking of the lateral eyebrows (the sides closest to the temples) and, in more severe cases, to a condition known as dermatochalasis (basically folded over, seemingly redundant skin of the upper lids).

Fortunately, the careful placement of a volumizing filler, such as Juvederm UltraPlus XC, directly into the lateral eyebrow region, as well as immediately under the eyebrows, can return the brow to its more youthful location and orientation, which is to flare upward and outward. The results typically evoke an immediate "Wow!"The ideal female forehead is somewhat rounded and projects outward. (Those of men, by contrast, typically jutt out directly above the eyebrows in the form of a horizontal ridge). With time, loss of volume here can lead to an unsightly flattening of the forehead and loss of that youthful projection. Fortunately, this, too, can be remedied by the use of an appropriate volumizing filler.

But, due to the richness and interconnecting nature of the blood vessels in the region, the filler must be placed directly and carefully over the underlying bone and in precise locations situated about half an inch below the hairline. Once injected as a bolus (basically a mound ), the filler is then gently massaged downward into place to achieve the desired effects of elevation and projection--gratifying overall enhancement that can be appreciated in the front face, as well as profile views. So, when it comes to the upper third of the face, simple treatments can truly make things look up.