Disease Description (Causes and Symptoms)
- Definition: A condition in which the facial skin and soft tissue sag or wrinkles develop because the dermal and subcutaneous structures degenerate or are lost due to age and external factors (aging face).
- Causes and pathophysiology
- Intrinsic factors: Age (aging genes), collagen and elastin breakdown, redistribution and loss of subcutaneous fat, muscle atrophy, reduced blood circulation, and decreased sebum and moisture.
- Extrinsic factors: Ultraviolet rays (photoaging), smoking, pollution, improper cosmetics and cleansing, repetitive facial expressions, and sleeping positions.
- Results: Degeneration of dermal elastic fibers and collagen → decreased skin elasticity, weakening of subcutaneous support tissue → sagging in the direction of gravity, wrinkle formation, fat protrusion (under the eyes), hollow cheeks, double chin, etc.
- Main symptoms
- Fine lines and nasolabial folds around the eyes, forehead, and mouth; drooping or fat protrusion of the upper and lower eyelids; sagging or hollowness of the cheeks; an indistinct jawline (double chin); and sagging neck skin.
Treatment Methods (Standard Treatments, Medications, Procedures/Surgery, Lifestyle Management, and Precautions)
- Conservative and lifestyle management
- Use sunscreen, moisturize sufficiently, maintain adequate fluid and nutritional intake, stop smoking, maintain regular sleep and manage stress, and avoid excessive weight loss.
- Nonsurgical treatments
- Botox (botulinum toxin): Improves dynamic wrinkles caused by facial expressions (between the eyebrows, around the eyes, forehead, etc.). Effects begin 2–3 days after the procedure, peak at 1–2 weeks, and last 4–6 months. Contraindications: Conditions such as myasthenia gravis; not recommended during pregnancy or breastfeeding.
- Fillers (such as hyaluronic acid): Relieve wrinkles, restore volume, and improve contours. Immediate effects, generally lasting 6 months to 1 year (varies depending on the substance and patient). Swelling and redness improve within several days.
- Laser treatments and dermabrasion (chemical, mechanical, or laser): Improve pigmentation, fine lines, and the skin surface. The recovery period and complications vary depending on the depth (deep dermabrasion may require hospitalization and extensive recovery).
- Surgical treatments
- Facelift: Dissection and tightening of the skin and fascia, followed by removal of excess skin — effective for severe sagging. Hospitalization, general anesthesia, drainage, and a recovery period are required.
- Blepharoplasty: Corrects drooping eyelids and fat protrusion.
- Forehead and brow lift, neck wrinkle surgery, etc.: Structural correction by area.
- After surgery: Drainage to prevent bleeding and hematoma; timing of suture removal (e.g., 5–7 days); swelling and bruising subside within several weeks.
- Precautions and complications (including treatment-specific considerations)
- Botox: Contraindicated during pregnancy or breastfeeding and in patients with myasthenia gravis. Excessive administration may cause ptosis and changes in facial expressions.
- Fillers: Allergic or foreign-body reactions, inflammation, bruising/swelling, overfilling, and vascular embolism (which may cause skin necrosis or vision loss) — immediate action is required.
- Surgery: Hematoma, infection, scarring, decreased sensation, facial nerve injury (temporary or permanent), and asymmetry.
- Systemic considerations: Risk is increased in people taking anticoagulants, smokers, and patients with chronic diseases (cardiovascular disease or immunosuppression).
- Recommendations when deciding on treatment
- Decide after thorough consultation with a specialist regarding the treatment goals (the likely degree of improvement and duration), recovery time, and possibility of complications.
- Before the procedure, review medications, health status, and records of previous procedures, and consult the doctor about temporarily stopping medications if necessary (e.g., anticoagulants).
Outpatient Visit Checklist (Preparation and Example Questions)
- Items to prepare (recommended to bring)
- A list of all medications and supplements currently being taken (especially anticoagulants, antiplatelet agents, antibiotics, omega supplements, etc.)
- History of allergies (including medications, local anesthetics, filler ingredients, etc.)
- Smoking status and whether there have been any recent attempts to quit smoking
- Records of previous surgeries and dermatologic procedures (Botox, fillers, laser treatments, etc.), including results and side effects
- Recent photographs (for comparing the original appearance and problem areas; front, side, and various facial expressions)
- Areas for which improvement is desired and reference photos
- Questions the doctor is likely to ask during the outpatient visit (examples)
- When the symptoms began and how quickly they have progressed (When did they start? Are they gradually getting worse?)
- The degree of skin exposure to sunlight in daily life and at work
- Experience with previous procedures (Botox or fillers) and whether there were any side effects
- Medications currently being taken and whether any chronic diseases are present
- Questions to prepare for the patient to ask the medical staff first during the outpatient visit (brief examples)
- What treatment options are available for my current condition?
- What are the recovery periods and estimated cost ranges for each treatment?
Examples of General Questions to Ask the Doctor
- What degree of improvement can be expected from this treatment (or surgery), and how long will the effects last?
- What are the main side effects of this treatment, and how often do they occur? How should I respond if a problem occurs?
- What precautions should I follow during the recovery period (such as medication use, activity restrictions, and wound care)?
- Do I need to stop medications I am already taking (e.g., aspirin or warfarin)? When should I stop them and when should I resume taking them?
- Can I undergo the procedure while pregnant or breastfeeding?
Examples of Condition-Specific Questions (2 Tailored Questions)
- Could you explain separately which problems on my face can be corrected only through surgery (such as a facelift or blepharoplasty) and which can be treated nonsurgically (with Botox, fillers, or laser treatments)?
- For the changes I want (e.g., removing fine lines around the eyes and restoring volume), what combination of procedures would you recommend (such as Botox + fillers + laser treatment), and what are the expected recovery periods and cost ranges for each?