Infraorbital Rim Augmentation / 'Squint' look

[Gregor Samsa]

Having said that, the thin skin in the eye areas makes implants tricky, especially over time.  I've seen cheek implants that after 10 years looked BAD

I've heard the same thing about fat grafts. In general, I think it's a bad idea to mess around with the soft tissue. I happen to have very thin skin in the eye area so I have to be extra careful when I consider what procedures would work well for me.

[Tiny]

I've heard the same thing about fat grafts. In general, I think it's a bad idea to mess around with the soft tissue. I happen to have very thin skin in the eye area so I have to be extra careful when I consider what procedures would work well for me.

Agreed.  Fat grafts are not advised in the eye area. I think for cheeks it's OK but for eyes, nope.  One of the good things about hyalauronic fillers is that they can be removed if necessary.  And the issue with implants in the eye area is that the skin is so thin, there is little camouflage

[PloskoPlus]

Posko, I think you have a quite heavy brow? If you get canthoplasty alone then your eyes could end up tiny but canthoplasty combined with a temporal browlift could give a nice result....if you want to go down the PS route.

I wouldn't say that my brow ridge it's neanderthalic, but it's significant.  Before I even knew what a maxilla was, I always thought that my eyes are small relative to my face - big temples, a broad and longish midface.  My surgeon said that building up under the eyes will make them look "too squinty".  I'm reluctant to admit it, but I think he has a better understanding of aesthetics than I have been giving him credit for.  For when I look in the mirror from about 3 meters, my eyes are dominated by the surrounding brow ridge, temples, big face. The eye bags, slight scleral show becomes unnoticeable. Though, IMO, small gun-slit eyes look better than small "sleepy eyes". 

I'm not sold on manipulating the soft tissue to fix eyes, especially when the problem is structural, rather than age-related.  IMO, beautiful eyes cannot be achieved surgically.

[Gregor Samsa]

Most plastic surgeons will tell you that aging related cosmetic problems are the result of the natural loss of bone substance in the face that happens as you age. It's very obviously a structural problem so I don't understand why anyone would think it makes sense to try to rearrange the soft issue to cover it up. Those of us with underdeveloped midfaces get all those problems for free that are normally associated with aging.

[PloskoPlus]

Most plastic surgeons will tell you that aging related cosmetic problems are the result of the natural loss of bone substance in the face that happens as you age.

Really?  I thought it was a relatively new discovery that facial bones shrink with age, and the common wisdom was that it's all soft tissue.

[Optimistic]

Really?  I thought it was a relatively new discovery that facial bones shrink with age, and the common wisdom was that it's all soft tissue.

How recent could that be?

The average person would likely be unaware of shrinkage in facial bones, though ironically this is almost entirely responsible for our perception of age in other people - not skin.

[PloskoPlus]

How recent could that be?

The average person would likely be unaware of shrinkage in facial bones, though ironically this is almost entirely responsible for our perception of age in other people - not skin.

I would say 10 years.

http://blogs.webmd.com/cosmetic-surgery/2010/05/our-face-sags-and-facial-bones-shrink.html

[Optimistic]

I would say 10 years.

http://blogs.webmd.com/cosmetic-surgery/2010/05/our-face-sags-and-facial-bones-shrink.html

What do you think this means for someone in their 50's? Should they be using radiesse to compensate for shrinking bone?

Would whole face HA paste be another possibility? Implants?

What can be done to augment the facial bone structure back to a youthful state?

[PloskoPlus]

What do you think this means for someone in their 50's? Should they be using radiesse to compensate for shrinking bone?

Would whole face HA paste be another possibility? Implants?

What can be done to augment the facial bone structure back to a youthful state?

Well, this guy is building his whole business on HA paste "rejuvenation".

http://bmendelson.com.au/

Though, IMO, skin condition is also very important (elasticity, sun damage).

[Tiny]

  IMO, beautiful eyes cannot be achieved surgically.

Agree

Well, this guy is building his whole business on HA paste "rejuvenation".

http://bmendelson.com.au/

Though, IMO, skin condition is also very important (elasticity, sun damage).

Smart guy.  I think in the next 5 years we are going to see a lot more surgeons going down this route.  So far the focus has been on sagging skin and tissues (facelifts/browlifts), loss of soft tissue volume (fillers) and skin condition (lasers, peels, make-up) and you do see some surgeons adding chin and cheek implants to make up for the lost bone.  But now they're getting an understanding of bone loss over time, the use of HA paste is going to become more prevalent

Generally most surgeons focus on anti-aging procedures more than beautification.  There are few that focus on the latter and they tend to do more things like jaw/malar augmentation, temporal browlifts etc

I got a quote off one of the only European surgeons doing HA augmentation and it was 4,500eur for cheekbones.  Probably going to wait and get it done when I get my jaw surgery

[Gregor Samsa]

I got a quote off one of the only European surgeons doing HA augmentation and it was 4,500eur for cheekbones.  Probably going to wait and get it done when I get my jaw surgery

Was that Mommaerts? I thought HA sounded good in theory at first but my own experience with it along with what Triaca supposely said about it makes me hesitant to have anything to do with it for the purpose of sculpturing the face.

[Optimistic]

Was that Mommaerts? I thought HA sounded good in theory at first but my own experience with it along with what Triaca supposely said about it makes me hesitant to have anything to do with it for the purpose of sculpturing the face.

Exactly my thoughts.

In theory HA paste is ideal for bone rejuvination, as Tiny puts it. Unfortunately, in the event I didn't misunderstand Triaca then that means HA paste would be counter-productive and very dangerous when applied in such a fashion. Of course, there's always bone grafting however that too has drawbacks. Namely that it acts exactly like real bone and will recede over time.

I wonder if this just leaves implants for now?

I have to say that I just don't 'get' how HA paste can do what Triaca is claiming. Hydroxyapatite is really just coral granules of which 80% of natural bone is comprised of. How could it cause erosion of bone? Why can't I find any studies to confirm this? All show long-term stability.

[Optimistic]

Well, this guy is building his whole business on HA paste "rejuvenation".

http://bmendelson.com.au/

Though, IMO, skin condition is also very important (elasticity, sun damage).

This is absolutely true, however to a point won't alter much of your perceived age. It'll make someone look some years younger (particularly as you get into advanced age), though ultimately it's going to make them look BETTER for their age.

Our perception of age is heavily associated with bone loss. How is it that someone caked in make-up and airbrushed with perfect skin will always look around their age? It's not like we can simply airbrush the face of a 40yo and suddenly we confuse them for a 20-something girl. Reason being bone loss leads to the loss of a triangular face shape, less facial fat, narrower midface, all those things give the perception of age.

It's also why attractive people 'age better'. They have more bone to lose and thus retain youthful features and appearance for longer.

my two cents.

[Tiny]

This is absolutely true, however to a point won't alter much of your perceived age. It'll make someone look some years younger (particularly as you get into advanced age), though ultimately it's going to make them look BETTER for their age.

Our perception of age is heavily associated with bone loss. How is it that someone caked in make-up and airbrushed with perfect skin will always look around their age? It's not like we can simply airbrush the face of a 40yo and suddenly we confuse them for a 20-something girl. Reason being bone loss leads to the loss of a triangular face shape, less facial fat, narrower midface, all those things give the perception of age.

It's also why attractive people 'age better'. They have more bone to lose and thus retain youthful features and appearance for longer.

my two cents.

I agree in part but not completely. There are many things that contribute to ageing.  One of the most major things is loss of contrast in the face.  Over time, the skin gets darker and everything else gets lighter.  That's why makeup works  - I think she looks a lot younger with makeup

http://www.maskcara.com/2013/01/07/age-is-beauty/


IMO the most aging things, facially, are - jowls, marionette lines and sagging mouth corners, followed by sagging brows and eye corners.  However it is true that a weak bone structure will make these things much worse.  I am already seeing sagging in the mid and lower face because of weak bone structure 

I wonder who ages worse - class 2s (with the underdeveloped mandible) or class 3s with the underdeveloped midface?

It will be interesting to see how this field develops over the next 10 years or so.  There are already a lot of techniques to address most aspects of ageing but bone degradation is something that is something that has so far, been pretty overlooked.  Ironically, I think some of the advances we are going to see in jaw surgery over the next 10-20 years will originally come from anti-aging cosmetic surgery and then get adopted by orthognathic surgeons. Simply because there are far more cosmetic surgeons vs jaw surgeons, the demand for anti-aging surgery is so high, and a 50 year old usually has more money than a <30 year old


Combination procedures - browlift, bleph + canthoplasty, midface lift




Canthopexy (but done with an awful and unnecessary browlift!!!)


Canthopexy

[Gregor Samsa]

Some of you seem to forget that Brad Pitt is 50 years old and still looks great. At what age is it okay to start looking old according to you people?