Aging Face and Neck

10.1055/b-0034-97705

Tracy S. Kadkhodayan & Marissa Tenenbaum

Middle-aged woman.
Skin: Minimal actinic damage and glabellar rhytids, crow′s feet and perioral rhytids.
Eyelids: Hooding of the upper lids and fat herniation of the lower lids.
Midface: Prominence of the nasojugal groove, nasolabial folds, and labiomental folds; midface descent and moderate jowling.
Neck: Moderate skin laxity and platysmal banding.

What does the patient specifically want improved? What are her primary concerns?
Previous facial procedures and surgeries.
History of hypertension, blood thinners/platelet inhibitors, smoking (must quit at least 4 weeks before surgery).

Facial analysis
- Upper third: Evaluate brow position, upper and lower eyelid laxity, lateral canthal position, presence of nasojugal grooves, forehead and periorbital creases (with and without animation).
- Middle third: Assess malar descent; presence of nasolabial folds, jowls, marionette lines; upper and lower lip fullness and wrinkling; angle of mouth (e.g., depressed oral commissure); projection of chin; nasal analysis (see Case 19).
- Lower third (neck): Evaluate skin laxity, degree of sub-cutaneous and subplatysmal fat, evidence of platysmal banding, measurement of cervicomental angle.

Fitzpatrick scale for skin type (Table 15.1)

Fitzpatrick scale for skin type
Type	Color	Tanning
I	White, very fair; often has freckles	Always burns, never tans
II	White, fair	Usually burns, rarely tans
III	Beige complexion, most common	Usually tans, occasionally burns
IV	Beige, Mediterranean complexion	Rarely burns, tans easily
V	Dark brown complexion	Rarely burns
VI	Black	Never burns, deeply pigmented