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About Face

Hollowing

Chapter Two Aging Skin Factors That Age the Skin How Skin Ages Hollowing Sagging Wrinkling Vitamin A Acid Cream Nonsurgical Face-lifts Injection Treatments Peels

Of the three main problems associated with aging of the skin, hollowing is the most easily explainable. It is a phenomenon associated with the late aging process and is a direct result of the wasting away or atrophy of fat under the bottom layer of skin, the subcutaneous tissue. When it happens in the areas of cheek or temple, or both, it creates a skeletal, sunken appearance.

Mid-cheek hollowing, just below the cheekbone, is usually associated with elderly people in their seventies and beyond, or with people who have very high cheekbones. Mid-cheek hollowing can also occur in people who naturally have very little fat in their cheeks. The problem shows up when they are in their forties and fifties. The cheek fat, or buccal fat as it is known, shrinks - giving the face a gaunt, haggard look. Some patients who suffer from this are perpetually sad looking. But hollowing can be easily corrected the mid-cheek area with a silicone implant - a procedure known as submalar augmentation. The implants come in various shapes and sizes to create the best possible effect for the patient. Unlike the material used in silicone breast implants, this silicone is solid.

Hollowing can also become apparent in people who suffer a grave illness. I once had a patient who was dying of ovarian cancer. To keep her spirits up over what turned out to be the last year of her life, she wanted to look in the mirror and see a healthy-looking face. In this case, I simply injected her at intervals with massive doses of collagen.

Another kind of hollowing can occur as a result of shrinkage around the “alveolar process” - the bony ridge containing the sockets of the teeth. Bony atrophy is often a result of having teeth capped or removing the upper four front teeth, and it can cause the nasal tip to droop. When the bone begins to waste away, the orbicularis oris muscle, the round muscle that encircles the lips, will shorten. In this area of the face, the skin is attached directly to the muscle, and so the shortening causes vertical lines around the lips, a bit like a collapsed accordion.

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