Facial drooping and laugh lines

Our face is part of our identity and bears the marks of our life history. The midface is the most visible determinant of an individual’s perceived age. A youthful midface is characterized by smooth midfacial skin without wrinkles or pigmentary changes, well-volumized cheeks whose point of maximum projection lies high on the cheek bones, an absence of irregular grooves and bulges, and transits smoothly and imperceptibly from the lower eyelid into the lower face. 

When viewed from the side, the midface should form a gentle convexity. Successful midfacial rejuvenation significantly reduces one’s perceived age, and imparts the image of someone who is confident, energetic and in good health.

How Does It Manifest?

Midface aging is associated with a constellation of changes and brings about the most significant difference to an individual’s perceived age. There is thinning and laxity of the skin, formation of fine wrinkles, and irregular deposition of skin pigmentation. There is deflation, descent and loss of the cheek prominence. Facial grooves and bulges form after the third decade: these include the tear trough deformity, midcheek groove, nasolabial folds (laugh lines), jowls and marionette lines. The lower eyelid, cheek and lower face appear to be one single unit in youth. 
 
With advancing age, these subunits of the face gradually become distinct and separate and are delineated by bulges and grooves. These changes may appear as sad, angry or tired-looking to others, and may adversely affect body image and social functioning.
Facial Drooping & Laugh Lines Treatment: Fillers, Structural Fat Grafting & Face Lifts

How does it arise?

Midfacial ageing is a complex multifactorial process involving the skin, subcutaneous fat, the facial muscle (SMAS) layer and the facial skeleton. These include:

  • Thinning of the lower eyelid skin leading to the formation of fine wrinkles due to reduced elastin and collagen fibre production, and reduction of hyaluronan in the skin. This results in the formation of fine wrinkles
  • Irregular deposition of skin pigment
  • Loss of fat from the superficial and deep fat compartments resulting in cheek flattening and descent. Loss of facial fat results in progressive prominence of the bony skeleton and contributes to skin excess and laxity. This is an important mechanism of ageing in individuals who have lost significant weight
  • Drooping of facial soft tissue that is unsupported by the facial ligaments. This leads to the formation of the laugh lines and jowls
  • Changes in the facial skeleton occur after the fourth decade, especially bone loss in the lower half of the eye socket, at the base of the nose and the upper jaw. This results in loss of support for the facial soft tissue and contributes to its drooping

The most important mechanism of facial ageing is the progressive lengthening and laxity of the SMAS muscle layer. Lifelong repeated use of our facial muscles for critical functions such as facial expression, speaking and eating results in its gradual elongation. The SMAS elongates in a downward and inward direction and is contributes to the formation of the laugh lines and marionette lines.

How are men and women different?

Women generally have thinner skin, fat and SMAS muscle layers. Non-surgical techniques of lifting the midface, including lasers, fillers, and thread lifts have more effect in women than in men, whose facial soft tissue is much thicker and heavier. Regardless of gender, where moderate-to-severe skin or muscle laxity exists, surgical tightening of the muscle (SMAS) delivers reliable, natural-looking and long-lasting facial rejuvenation results that are difficult to achieve by non-surgical techniques.

Droopy Face and Neck Correction: Face Lift And Neck Lift for Men

treatment

The optimal treatment for frown lines depends on their severity, the individual anatomy and treatment goals. The options for the treatment of facial drooping include filler injection, structural fat grafting, microfocused ultrasound (MFU) skin tightening, thread lifts, mini face lifts, and face lifts. Attaining beautiful and bespoke results that retain an individual’s expressivity is frequently possible. Successful outcomes help to improve body image, self-esteem and social functioning.

Filler injection

Filler injection in Singapore is a popular ambulatory procedure and is often used for restoring soft tissue volume in areas where age-related fat loss has occurred or augmenting facial skeletal deficiencies. There is a wide range of fillers with various different characteristics to suit each individual’s unique anatomy and help them meet their aesthetic goals. 

Structural Fat Grafting

Structural fat grafting involves harvesting fat from areas of excess, purifying it, then grafting it in volume-deficient areas. A high proportional survival of fat cells may be attained with the use of specialized fat grafting cannulas available at Picasso Plastic Surgery. Structural fat grafting delivers elegant and long-lasting results. Structural fat grafting is a minimally-invasive ambulatory surgical procedure performed under local anaesthesia, with optional intravenous sedation if requested. 

Microfocused Ultrasound Face Lift

There is an increasing interest in non-surgical facial rejuvenation and microfocused ultrasound (MFU) has emerged as one of the effective and safe technologies for tightening of the skin and subcutaneous tissues. This is a popularly requested procedure for rejuvenation. The MFU face lift is an ambulatory procedure performed under local anesethesia nerve block and intravenous sedation for optimal effect.

Individuals with early facial drooping and good skin quality are good candidates for MFU face lift. These are usually individuals in their thirties or early forties. Individuals with other accompanying signs of facial aging such as face or neck skin and muscle laxity, double chin deformity etc. may wish to consider face lift surgery for comprehensive correction of these deformities.

MFU uses microfocused sound waves that generate vibration and heat at specific points in tissue. This creates areas of controlled thermal injury zones at predetermined depths. At these areas of thermal injury, the collagen contracts and is eventually absorbed by the body. New collagen production stimulated resulting in skin renewal. A detailed explanation of MFU treatment may be found here.

Administering effective and safe treatments are the cornerstones of our care delivery philosophy at Picasso Plastic Surgery. Effective MFU treatment requires repeated delivery of high doses of energy, which may sometimes render the treatment slightly painful. Utilizing our detailed knowledge of anatomy, MFU treatments are performed under regional nerve blocks with local anesthesia for maximal comfort, with optional intravenous sedation if individuals request for it. This allows individuals to tolerate higher doses of treatment to obtain a visible clinical effect in a safe and comfortable manner. Individuals who do not receive optimal analgesia often receive suboptimal treatment doses and may attain less satisfactory results. Our clinic uses the Ulthera (Ultherapy) system, which is the most extensively studied MFU device and was approved by the United States Food and Drug Administration in 2009 for non-surgical skin tightening.

The effects of MFU may be observed almost immediately following the procedure. There is continued improvement up to 3 months post-procedure due to continued collagen production and skin remodeling. The effects are sustained for 6 to 9 months in most cases. Repeat treatment is required to maintain the result.

No special post-procedural care is required. Individuals may resume their usual activities following the procedure.

Face Lifts in Singapore

Thread Lift

Thread lift procedures are based on the use of barbed sutures to elevate the skin and soft tissue of the face. It does not reduce the facial skin excess, replace the fat volume loss nor tighten the SMAS muscle layer. This is an ambulatory procedure performed under local anesthesia, with optional intravenous sedation if requested.

Individuals in their thirties or early forties with minimal skin laxity desiring minimal recovery time may consider thread lift. Individuals with other accompanying signs of facial aging such as face or neck skin and muscle laxity, facial hollowing, double chin deformity etc. may wish to consider face lift surgery for comprehensive correction of these deformities.

The number of barbed sutures, their vectors, and their placement position are tailored to every individual. Local anesthesia nerve blocks are administered for maximal comfort during the procedure.

The effects of thread lift may be observed almost immediately following the procedure. The effect of thread lifts last for a few weeks. Stress relaxation is a basic plastic surgery principle and occurs here: skin lengthens in response to tension. This tension occurs because the underlying SMAS (muscle) laxity is not corrected by the thread and remains lax with this procedure. The SMAS continues to exert downward traction on the skin and results in its subsequent elongation. Historical experience with face lifts that only excise skin (in the 1950s) showed that the result of such face lifts lasted only a few weeks to months. Individuals require repeat treatments to maintain this result.

Very subtle swelling is expected after treatment, and will normally settle after one to two days. Most individuals are able to return to work on the day following the procedure.

Individuals are advised to avoid vigorous massage or rubbing of the treatment area for 24 hours to permit the threads to engage the soft tissue optimally and prevent loss of effect of the thread.

Mini Face Lift | Short scar rhytidectomy

The mini facelift effectively elevates the midface and lower face through a short, inconspicuous scar that is sited between the ear and the face. This procedure significantly reduces the tear trough deformity, mid-cheek groove, laugh lines and marionette lines and keeps recovery time to a minimum. It produces sustained and exquisite results and is a popular aesthetic procedure.

There is often more significant improvement and long-term expenditure reduction with mini facelifts as compared with recurrent treatment with non-surgical therapies. It is performed as an ambulatory procedure under intravenous sedation and local anaesthesia.

The following are good candidates for a mini face lift:

  • Individuals with mild-to-moderate midface and lower face skin and muscle laxity seeking long-term improvement. These are usually individuals in their thirties to forties.
  • Individuals with mild-to-moderate tear trough deformities, midcheek grooves, laugh lines and/or marionette lines
  • Individuals who have had suboptimal results with non-surgical treatment(s)

The mini face lift tightens and elevates the cheek and lower face. It effaces unsightly droopy bulges and effaces the facial grooves, i.e. the tear troughs, midcheek grooves, laugh lines, jowls and marionette creases. The cheeks are elevated and revolumized, recreating the gentle concave contours seen in youthful face. Excess loose skin is excised to create a crisp, smooth skin contour and the scars are inconspicuous when healed. The result is elegant and harmonious improvement of the individual’s facial appearance, and reduction of the perceived age. Successful outcomes help to improve body image, self-esteem and social functioning.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling. Hypertension, if present, should be well-controlled, and smoking needs to be stopped for at least 2 to 4 weeks prior to surgery to minimize the occurrence of complications.

Mini face lifts are performed through incisions sited between the ear and the face for optimal scar concealment. The SMAS (muscle) layer is well-exposed and premits comprehensive tightening using proprietary techniques that deliver enhanced results and minimal recovery time. SMAS tightening eliminates the facial bulges and grooves and restores a smooth contour in the midface and lower face. SMAS tightening is also the critical step in face lift surgery and delivers effective, long-lasting and natural-looking results. Mini face lift surgery is a fine art and strikes a balance between effective facial elevation and tightening whilst avoidance of an overly-tightened and unnatural appearance.

Structural fat grafting is often performed to the superficial and deep fat compartments to reverse age-related fat loss. Finally, the excess skin is excised and wounds are meticulously closed for optimal postoperative outcome. In men with sideburns, special modifications are performed to prevent advancement of the sideburn hair onto the ear tragus.

Stitches are removed on the 5th postoperative day. Mild swelling and bruising is expected, which will mostly resolve by the 10th postoperative day. Most individuals are able to return to work following removal of stitches.

Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed when asleep at night. Strenuous activity should be avoided for the first two weeks to minimize bruising.

Dr Yeo is passionate about facial rejuvenation with non-surgical and surgical methods, and he delivers lectures in the Asia Pacific region on this topic. He applies proprietary SMAS modification techniques that are the key to delivering enhanced results while minimizing postoperative recovery time. Picasso Plastic Surgery has an en suite operating facility that assures you maximal privacy and convenience, and keeps facility and equipment costs contained.

Face Lift | Rhytidectomy

Rhytidectomy is the most comprehensive method of rejuvenation of the midface, lower face and neck. It addresses the multiple causes of facial aging and produces effective, elegant and long-lasting results. The scars are well-concealed at the junction between the face and the ear, and between the posterior hairline and neck. 

Rhytidectomy corrects many of the aging changes that cannot be effectively achieved by non-surgical methods because of its ability to tighten the SMAS (muscle) layer and to excise loose and redundant skin. There is often more significant improvement and long-term expenditure reduction with rhytidectomy as compared with recurrent treatment with non-surgical therapies. It is performed as an ambulatory procedure under intravenous sedation and local anesthesia.

The following are good candidates for a face lift:

  • Individuals with any degree of midface, lower face and neck aging seeking long-term improvement
  • Individuals with significant facial bulges and grooves, including tear trough deformities, midcheek grooves, laugh lines and/or marionette lines
  • Individuals with significant facial fat loss and skin laxity
  • Individuals who have had suboptimal results with non-surgical treatment(s)

The face lift tightens and elevates the cheek, lower face and neck, reduces unsightly droopy bulges and effaces the facial grooves, i.e. the tear troughs, midcheek grooves, laugh lines, jowls and marionette lines. The cheeks are elevated and revolumized, recreating the gentle concave contours seen in youthful face. There is improvement to the contour of the lower face and neck. Excess loose skin is excised to create a crisp, smooth skin contour and the scars are inconspicuous when healed. The result is elegant, comprehensive and harmonious improvement of the individual’s facial and neck appearance and reduction of the perceived age. Successful outcomes help to improve body image, self-esteem and social functioning.

Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling. Hypertension, if present, should be well-controlled, and smoking needs to be stopped for at least 2 to 4 weeks prior to surgery to minimize the occurrence of complications.

The face lift is performed through well-sited incisions in the hairline, between the ear and the face, and between the neck and posterior hairline. This gives maximal visibility of the SMAS (muscle) layer and permits application of proprietary SMAS tightening techniques that deliver enhanced results whilst minimizing recovery time. SMAS tightening eliminates the facial bulges and grooves and restores a smooth contour in the midface and lower face. In the lower face, SMAS tightening effaces the marionette lines and improves the lower jaw definition. SMAS tightening is the critical step in face lift surgery and delivers effective, long-lasting and natural-looking results. Face lift surgery is a fine art and strikes a balance between effective facial elevation and tightening whilst avoidance of an overly-tightened and unnatural appearance.

Structural fat grafting is often performed to reverse the age-related fat loss in the superficial and deep fat compartments. Finally, the excess skin is excised and wounds are meticulously closed for optimal postoperative outcome. In men with sideburns, special modifications are performed to prevent advancement of the sideburn hair onto the ear tragus.

In some cases, an incision may be placed at the back of the chin for further tightening of the neck muscles, excision of the double chin (fat) and recreation of an aesthetic neck angle.

Stitches are removed on the 5th postoperative day. Mild swelling and bruising is expected, which will mostly resolve by the 14th postoperative day. Most individuals are able to return to work after 1 week.

Neck swelling is improved by lying supine on a neck pillow only (without a head pillow) when sleeping at night for the first 2 to 3 days. Gentle face washing is possible from the second postoperative day onwards. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed when asleep at night. Strenuous activity should be avoided for the first two weeks to minimize bruising.

Facial rejuvenation with non-surgical and surgical methods is one of Dr Yeo’s key clinical interests, and he delivers lectures in the Asia Pacific region on these topics. He applies proprietary SMAS modification techniques that are the key to delivering enhanced results, while keeping postoperative recovery time to a short duration. Picasso Plastic Surgery has an en suite operating facility that assures you maximal privacy and convenience, and keeps facility and equipment costs contained.