What are the procedures for correcting facial aging?

Procedures for Correcting Facial Aging

For correcting facial aging, prioritize autologous platelet concentrates (APCs), particularly platelet-rich fibrin (PRF), as the primary regenerative treatment targeting the underlying vascular degeneration and fat atrophy, supplemented by botulinum toxin for dynamic wrinkles and hyaluronic acid fillers for volume restoration in specific anatomical zones. 1

Understanding the Pathophysiology

Before selecting treatments, recognize that visible aging signs (wrinkles, laxity, folds) stem from deeper tissue-level changes that are not clinically visible 1:

• Vascular degeneration is the primary initiator of facial aging, causing decreased blood flow and subsequent oxygen/nutrient deprivation 1
• Deep fat atrophy results from this diminished blood supply, leading to loss of subcutaneous volume and skin tone 1
• Muscle hypertrophy with aging causes permanent hypercontraction, creating involuntary dynamic wrinkles 1
• Bone resorption in preferential areas compounds soft tissue descent 2

Treatment Algorithm by Anatomical Zone

Priority Treatment Areas ("Hot Spots")

Start with periorbital and perioral regions, as these areas have minimal subcutaneous fat and show aging signs earliest 1:

Periorbital Region

• Tear trough deformity, infraorbital hollowness, dark circles 1
• Crow's feet and periocular wrinkles 1
• Supraorbital hollowness 1

Perioral Region

• Nasolabial folds 1
• Marionette lines and jowls 1
• Perioral wrinkles and lip volume loss 1

Evidence-Based Treatment Modalities

1. Autologous Platelet Concentrates (First-Line for Regeneration)

PRF demonstrates superior outcomes compared to PRP in all comparative studies and should be the preferred platelet concentrate 1:

• Mechanism: Addresses the root cause by promoting vascular regeneration, reversing fat atrophy, and stimulating collagen synthesis 1
• Administration: Intradermal papule injection or microneedling at 0.25mm depth for periorbital areas 1
• Novel advancement: Heated plasma "albumin gel" formulations provide 4-6 months duration while building collagen over time 1
• Safety profile: More natural and safer than synthetic fillers, being autologous 1

Clinical evidence: Two sessions of plasma gel showed significantly better periorbital rejuvenation results than PRP, with positive treatment response even in patients over 60 years 1

2. Botulinum Toxin (For Dynamic Wrinkles)

FDA-approved botulinum toxin products achieve 68-70% responder rates for glabellar lines (≥2-grade improvement at Day 30) 3:

• Specific indications: Glabellar lines, forehead wrinkles, crow's feet caused by muscle hypercontraction 1, 3
• Dosing protocol: 20 Units total for glabellar complex (4 Units per injection site × 5 sites: one procerus, two per corrugator supercilii) 3
• Mechanism: Blocks acetylcholine release, producing localized muscle denervation and reduced activity 3
• Important caveat: Only addresses dynamic wrinkles from muscle contraction, not volume loss or skin quality 2

3. Hyaluronic Acid Fillers (For Volume Restoration)

Use strategically for specific volume deficits in conjunction with regenerative treatments 1:

• Target areas: Malar fat pad atrophy, tear trough deformity, lip volume loss 1
• Limitation: Provides immediate volume but doesn't address underlying vascular pathology 1
• Combination approach: APCs offer more natural results and can be combined with fillers for comprehensive correction 1

4. Fat Grafting

Consider for significant deep fat atrophy when volume loss is the predominant feature 1:

• Rationale: Addresses the gradual loss of fat volume from subcutaneous tissues that decreases skin tone 1
• Common application: Frequently utilized strategy in facial esthetics for structural support 1

5. Adjunctive Laser Therapy

Combine with APCs for all-natural therapeutic options targeting skin quality 1:

• Synergistic effect: Lasers address surface texture while APCs promote deeper regeneration 1
• Advantage: Provides comprehensive treatment without synthetic materials 1

Treatment Session Protocol

Based on available evidence, optimal APC protocols require:

• Multiple sessions: Typically 2-4 treatment sessions for periorbital rejuvenation 1
• Combination with microneedling: Shows more rapid efficacy than either modality alone 1
• Interval timing: Studies show improvement maintained through 3-month follow-up 1

Critical Pitfalls to Avoid

1. Don't treat only surface manifestations: External wrinkles and folds always relate to deeper tissue-level pathology 1

2. Don't ignore the underlying vascular component: Vascular degeneration initiates the aging cascade; addressing only volume or muscle activity provides incomplete correction 1

3. Don't use botulinum toxin for static wrinkles: It only works on dynamic wrinkles from muscle contraction 3, 2

4. Don't overlook bone resorption: Preferential areas of bone loss correspond to most pronounced soft tissue aging 2

5. Avoid over-reliance on synthetic fillers alone: APCs provide more natural, regenerative results with better safety profiles 1

Regional-Specific Approach

Upper face: Botulinum toxin for forehead/glabellar lines, APCs for supraorbital hollowing 1, 3

Midface: APCs for malar fat pad atrophy and vascular regeneration, fillers for immediate volume if needed 1

Lower face: APCs for marionette lines and perioral wrinkles, consider fat grafting for significant jowling 1

Periorbital: APCs via microneedling or intradermal injection for dark circles, hollowing, and wrinkles 1