| Deep wrinkles and folds are due to loss of volume of the fat cushions that support the contours of the youthful face. As a general rule up to the age of sixty the main cause for deep folds and wrinkles is the loss in volume of the supporting fat cushions and not gravity.
The fat pads that plump the cheeks, tear troughs and mental or chin area, soften the bony rim around the eye and the point of the chin. This results in an “owl”-like bony prominence around the eyes, deep nose to mouth lines. Conversely, increase in the sub mental fat pad or fat pad beneath the chin combined with the loss of volume from the cheek fat pads, results in the formation of early “jowls” and a gaunt appearance.

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| Photographs courtesy of Sanofi-aventis, manufacturers of Sculptra |
This volume can be restored with either dermal fillers or various products which stimulate your own skin to produce more collagen and in doing so replace the loss of volume of the fat cushions. Products such as dermal fillers can also be used to plump out some of the deeper lines and folds. Even after sixty years of age some individuals benefit from cosmetic dermatology. However, in the case of very advanced skin laxity plastic surgery may be an option. The option between cosmetic dermatology and surgery depends very much upon what the individual’s desires and expectations.

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