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Young and Old Faces. A Helpful Analogy

Today, I saw two women in the Beverly Hills office who were interested in fat grafting. One was 25 years of age and one was 45 years of age. This reminded me the difference between younger faces and older faces when it comes to facial volume loss and shape. A good analogy to describe the analogy of the young and elderly face is the heart. The young face shape in youth is that of a heart. It is wider on the top than on the bottom. This is the shape that we call strive to achieve with facial remodeling or face lift surgery. Much of these changes from heart to upside down heart are related to fat loss and gravity. In younger people, generally the problem appears to be volume loss with very little or no descent of pre existing fat. For example, the malar fat pads (the area under the eyes) can still be in the proper regions high on the cheek in younger women and men. In elderly people, not only is there volume loss, there is also descent of the fat pad. Whereas the younger woman who I saw will benefit simply from fat grafting to replace the loss of fat under her eyes and augmentation of cheek bones, the woman who is 45, if she underwent fat grafting alone, would appear to have a very fat face with little or no definition in the high cheek bone region. The goal in rejuvenating the face is to turn a bottom-heavy face into a top-heavy face. An upside down heart to a heart. The ideal way of doing this is to re-suspend or raise any descent of the malar fat pad to a higher position with the troughs below the eyes fat grafted.

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