Dr. Ritu Malhotra, of Cleveland, Ohio, is one of the nation’s most experienced board certified facial plastic surgeons. In just under two decades she has performed nearly 4,000 facial plastic surgical procedures. Her special combination of charisma, passion, and confidence has won her multiple recognition awards for superior ratings in patient satisfaction.
Do you look in the mirror and see a tired face or a sagging jawline? What if:
You could firm your jawline in a way that looks completely natural?- It was actually affordable?
- It only took a couple of hours?
Understanding facial aging can help you head off time’s effects. Awareness of rejuvenation treatments will help you to appreciate what will work best for the specific changes you want to make to your appearance.
The Elements of Facial Aging
Changes that give your face a tired and aged appearance:
- Skin changes
- Volume loss
- Muscle/ligament changes
- Gravity
- Fat accumulation
However, you can diminish or reverse these effects.
Skin Changes
As we age, our skin loses elasticity and begins to retain lines where expressions cause it to fold, and wrinkles form. The skin gains a translucent, crepe-like appearance. You can reduce the impact of sun damage and a loss of nutrients 
by utilizing a recommended Skin Care regimen—with a cleanser, toner, prescription strength skin lightener and exfoliator.
In addition, as you age, the skin’s normal rejuvenation process slows so that a growing number of cells on the surface are older and more damaged.
You can inexpensively counteract these changes using laser skin peels for resurfacing or laser collagen rejuvenation to stimulate the skin’s natural renewal process.
Loss of Facial Volume
With age, the body changes its patterns of fat deposition. The face loses priority, so it begins to lose fat. This is worsened by the displacement of tissues by gravity, creating a haggard, worn, or tired appearance. This can be countered using affordable dermal fillers such as Restylane®, Juvederm® or Radiesse® or fat grafting.
Changes in Facial Tissues
It’s not just skin and fat, even some of the facial ligaments can lose elasticity. This contributes to the displacement of facial tissues. Where the ligaments retain their tautness, it can create facial grooves.
These grooves can be concealed using dermal fillers such as Restylane®, Juvederm®, or Radiesse® or fat grafting.
Over time the muscles become conditioned to repeated responses and will anticipate routine contractions. In the face, this leads to the formation of permanent, inscribed folds where there should only be temporary ones.
The best treatment for relaxing these over-enthusiastic muscles is Botox Cosmetic.
Displacement of Tissues by Gravity
Gravity works constantly to pull everything on the body downward. In the upper face, the brow and eyelids can begin to sag, creating a tired or angry appearance. Hanging skin and fat in the lower face produce jowls. Deep facial folds are formed around the mouth and nasolabial area.
The solution to tissues displaced by gravity depends on the degree—mild, moderate or severe.
- Mild usually occurs in the 30-50 age range. Thermage® is a wonderful, reasonably priced option for both drooping of the eyelids and jowling in the lower part of the face.
- Moderate can appear in your 50s and 60s. Options include Thermage® full face with or without eyes or a Lift that is individualized to your specific needs.
- Severe tends to develop in the 60s, 70s, or 80s. Solutions include a lift that addresses both face and neck often along with eyelid surgery and brow Lift —to correct gravity changes all over.
Excessive Fat Accumulation
One of the first signs of facial aging is that your eyes get puffy. This is caused by an increase of fat in the upper and lower lids. The only solution to this particular problem is Eyelid Surgery as it removes these fat pockets or “bags.”
Fat also accumulates in the jowl area and in the neck area. This causes loss of the definition of the neck and makes the chin appear weaker.
Smartlipo™ is minimally invasive laser lipolysis, and traditional chin and neck liposuction are both options to be discussed.
A version of this article that includes Dr. Malhotra’s pricing for many of the procedures listed here is available by emailing her practice, the Enhanced Image Center in Cleveland, Ohio at rmalhotra@enhancedimagecenter.com.
