Facelift Series #3: Facial Aging w/ Dr. Kylie Edinger

When we’re young, our faces have a smooth, full look thanks to well-defined fat pads and tight connective tissue. But as we age, those structures start to change, leading to sags, bags and changes in facial shape.

Facial aging doesn’t happen all at once. It’s a gradual process that starts as early as your 20s. At first, the face can look more sculpted and angular, but over time, fat volume loss,  drooping, and eventually muscle and bone changes become more noticeable.

Restoring a youthful look often means going beyond just the skin. It takes a thoughtful approach that can include restoring lost volume, repositioning fat and connective tissue, and tightening the skin.

Drs. Bass and Edinger break down how facial aging really works, from the inside out, and why understanding these changes is key to treating them effectively.

Learn more about facelift surgery

About Dr. Kylie Edinger

Dr. Kylie Edinger is a plastic surgeon currently spending a year training as an aesthetic plastic surgery fellow with Dr. Bass and a host of other world class plastic surgeons at Manhattan Eye, Ear, and Throat Hospital in New York City. She’s part of the prestigious Northwell Health program—one of the top aesthetic plastic surgery fellowships in the country. Before making her way to NYC, Dr. Edinger completed her plastic surgery residency at the University of Wisconsin.

Follow Dr. Edinger on Instagram @kylieedinger

About Dr. Lawrence Bass

Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.

To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc

Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass. 

Episode Transcript

(00:01):
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass Park Avenue plastic surgeon,
educator and technology innovator.
Today's episode is number three inour facelift series, Facial Aging.

(00:25):
What are principals involved in facialaging and why are they important?
Surgery is all aboutanatomy and structure,
so it's really important tounderstand normal youthful
anatomy and then understandhow that changes with
age.
That teaches us how to restoreit to a youthful state.

(00:48):
The basic structure of the faith in youth,
we have skin, connectivetissue, subcutaneous fat,
a fibroseptal network,
and then there arethicker areas within this.
So we start with the skin at the surface.
Underneath the skin is a layer of fat.

(01:09):
Even in thin people, there'sa little bit of fat there,
and some thicker fat padsthat make some of the
shapes in the face.
Underneath the fat is connectivetissue that sits over the
muscle.
That's the SMAS layer or SuperficialMuscular Aponeurotic System.

(01:30):
It's a connective tissuelayer over the muscle.
What runs through thefat in between the skin
and the connectivetissue are little fibers,
connective tissue fibers madeof collagen that hold the skin
down against the underneath.

(01:50):
That's why our skin doesn't poolaround our ankles and around our
waist and around our jawbecause it's held in place,
particularly in youth.
And there are certain areas where thoseconnective tissue fibers are thicker
or coalesce,
and that creates a strongfixed attachment point,

(02:12):
what we call a ligament,
even though it's technicallynot a ligament like the orthopedic surgeons need,
and those ligamentscompartmentalize the fat
layer into those discreet fat pads.
Okay, and what happens to skin with aging?
Well, as we age,

(02:32):
our skin undergoes intrinsic changes dueto the natural aging process and also
extrinsic exchanges due to environmentalexposures and influences like sun
smoking, hydration inyour diet. Over time,
our skin produces less collagenand elastin leading to laxity,
and it also offends as we age,making it more prone to wrinkles.

(02:53):
We see all these changes below the skinand in deeper structures of the face as
well as we age.
So Dr. Edinger has justoutlined a multitude of factors
that are affecting our facethat affect the aging appearance
of the face. In the old days,
we thought it was just theskin becoming less elastic,

(03:15):
but now we understand that thereare many other things involved,
and that means we haveto engage with those
anatomic structures and thechanges in those structures if we
want to restore the face.
That makes sense.
So what are these changes in therest of the facial structures?

(03:37):
When we start out in youth but grown up,
let's say in our twenties, wehave typically the baby face.
Most people in their twentiesstill have a lot of fullness in the
face,
and we recognize unconsciously justwhen we glance at someone that that
person is young. As we age,

(03:59):
start to come out of our twenties,
we start to lose fat in the face,
and that means we're losingvolume. Our shape is changing,
flattening. We're losingsome of the projection,
particularly early on in themidface, but eventually everywhere.
And that progresses at firstto a little more sculpted look.

(04:22):
In our thirties,
we typically have a little moreangular sculpted look to the face.
That may be our best look.
But the problem is thefat loss doesn't stop.
It continues and it eventuallybecomes too much of a good thing.
We not only lose thechubbiness of the baby face,

(04:43):
but we start to actuallysink in and hollow. And if we
think of people who are verymuch older, you see that worn,
haggard and hollowed out lookthat the face assumes with
the extremes of age. Soit starts as fat loss,
but when we get into our laterfifties and certainly in our sixties,

(05:07):
we're also losing muscle volume and we're
losing bone mass.
So the shape of our facial bonesthat provide the underneath
scaffolding for the faceare starting to thin,
recede and flatten,
and that gives us a loss ofprojection in the face and a

(05:28):
change in the shape of the faceto more of an aging change.
In addition to that laterprogression of loss of fat
means that we get anemptying or a volume loss as
well as a descent of fat pads.
But the important thing tounderstand is that each fat pad

(05:51):
loses a different amount anddescends a different amount.
And in addition to the fat pads changing,
we get atrophy of those ligamentsor connective tissue fibers.
They become less elastic and webelieve they lengthen or stretch
out,
and that contributes tosagging of the fat that

(06:14):
was up in certain places,
like against our chic bonethat now sags down lower and
creates sags, bags,
bulges in the face that arenoticeable as aging changes
and not a youthful shape.
So all of that changing inthe fat pads means what was

(06:34):
confluent and smooth in youth now shows as
individually identifiableshapes, sags and bags,
and that's amplified by theloss of skin elasticity and
thickness. These young springy,
elastic full skin holds everything into

(06:55):
a smooth confluent shape.
So even shapes on the face that looklike single shapes like our cheek are
actually made up of multiple fat pads,
as well as multiple layersof fat pads and all of that.
As it starts to lose elasticity,
sag as skin thins will show itself,

(07:18):
everything changes the skin,
the connective tissue orSMAS layer, muscle and bone.
So overall,
you're getting a changebetween the skin and the SMAS,
and you're getting a change in the amountof volume that's interposed between
those two tissue layers.

(07:38):
And these altered relationshipsbetween the layers in
conjunction with the volume lossare the main culprits of an aging
appearance in the face.
Thank you for outlining allthose changes, Dr. Bass.
Are there any other changes to consider?
We also see a separation in the neckplatysmal muscle that we refer to as a

(08:00):
diastasis,
where that midline muscle edge beginsto separate and can lead to platysmal
banding and a more obtuseangle below the neck over time.
Okay, so I'm starting to get a handleon the aging changes on the inside.
What does that translate toand what we see on the outside?
On the outside,
patients will notice all of the thingsthat bother patients and prob them to

(08:23):
potentially seek out a facelift surgery.
So we'll see deepening of nasolabialfolds, jowling, marionette lines,
platysmal banding, skin laxity,hollowing with loss of volume.
So the face takes on a more rectangularshape as it ages in contrast to the
softer heart shaped faceof the youth as well.
Right? That's sort of asquaring out of the face.

(08:45):
Normally,
our cheekbone area is the widestpart of the face in youth,
the youthful face kind of looks like anupside down egg with the thin part on
the bottom and the wider part on top.
As we age and everything sags down,
the mid portion narrows flattens and loses

(09:06):
projection, and thebottom part widens out,
and we come to that morerectangular appearance.
Okay, and now time for takeaways.
Aging changes in the faceare going on from early
on in our adult face in our twenties,
and some of those early changesgive us a little more definition in

(09:30):
our appearance. However,
with the progression of aging,
the accumulation of volumeloss in the fat loosens our
face and also changes ourfacial shape, as you just heard.
Dr. Edinger describe.
So we restoring a youthfulface ends up being

(09:51):
about restoring all of the tissue layers
as needed, restoring fat into the face,
repositioning fat in the face,
repositioning connective tissueelements like the SMAS layer
and repositioning skin.
The thing that facelift does notaddress is the quality of the

(10:15):
skin. So it gets positionedback to its youthful location,
but we're not changingthe quality of the skin in
terms of its texture,elasticity, thickness,
and that requires a separateset of treatments to
broaden out the scope of therejuvenation that's taking place.

(10:38):
Thank you,
Dr. Bass and Dr. Edinger for providingso much insight into facial aging and
essential background for understandinghow facelift approaches these changes.
Watch for our next episodein the facelift series,
Facelift Fears to find out whypeople are afraid of the facelift.
Thank you for listening to the ParkAvenue Plastic Surgery Class Podcast.

(10:59):
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(11:23):
@drbassnyc.