Cosmetic Treatment

Beauty and Aging


  • Beauty is a universal component of the human experience which promotes pleasure, rivets attention and impels action that helps ensure survival of the genes
  • In 5 B.C the Roman author Ovid wrote ‘The art of beauty’, the first known book on beauty and cosmetics, detailing the use of black eye shadow from wood ash and golden eye shadow from saffron
  • Studies have shown that by the age of 3 months, babies stare longer at attractive faces than those judged less attractive.
  • Attraction to beauty also makes sense from a disease perspective. It is said that “beauty is a burden that only the healthy can carry”- In other words, the sickly are by nature not attractive
  • Those with an ideal physique and youthful proportions are much more likely to be healthy and able to reproduce
  • In the same workplace, attractive people were found to earn up to 12% higher wages as compared to co-workers who were considered average-looking
  • In general, mathematically idealised proportions translate into symmetrical, oval to heart-shaped face with prominent cheekbones
  • There are racial variations



  • Females should have an arch- more in the lateral 3rd of the brow
  • Male is more flat


Gender differences in characteristics of attractive human faces

Idealised female facial features

  • A larger, smooth forehead with a smaller nose
  • Eyebrows that have an arch or gull-wing shape
  • Eyes that are set wider apart, creating a bigger look
  • Prominent cheekbones
  • A heart-shaped taper to the lower face, with a smaller lower: upper face ratio
  • Full vermilion lips

Idealised male facial features

  • An overhanging, horizontal brow with minimal arch
  • Deeper set eyes that look closer together
  • A somewhat larger nose
  • A wider mouth
  • A squared lower face with a more equal ration of lower: upper face
  • A beard or coarser texture to the lower facial skin

Aging Face

Types of Aging

  • Chronological- genetics, age
  • Photoaging- UV rays, smoking, nutrition, exercise

Understanding facial Ageing


  • Bone ageing including dental structure
  • Fat Ageing
  • Ligaments
  • SMAS layer
  • Muscle
  • Skin


  • Genetics
  • Hormones
  • Sun exposure
  • Lifestyle
  • Muscle wear and tear
  • Masseter hypertrophy: Idiopathic, bruxism

Types of Skin Aging

Glogau Photoaging Classification


  • Laxity of the skin and the subcutaneous tissues count only for a part
  • Loss of volume and volume shifts from the fat and bone contribute much more significantly

Anatomy Of Aging Face

  • The upper third elongates due to recession of the frontal hairline and brow ptosis
  • Middle third remains relatively stable- however, mid-face volume loss can occurs as a result of fat redistribution and skeletal changes
  • The lower third of the face becomes shortened with perioral fat redistribution and significant resorption of the mandible

Rhytides (Wrinkles)

  • Exaggerated appearance of some facial muscles
  • UV radiation-induced damage
  • Loss of skin elasticity
  • Repetitive movement of underlying facial musculature
  • Changes in volume from fat redistribution and bone as well as cartilage resorption


Subcutaneous Layer

  • Aging face is multifactorial
  • A complex ongoing alteration in proportion as one ages
  • There are multiple distinct layers of subcutaneous fat compartments in face that act independently from one another
  • The malar fat pad in the mid cheek is composed of three separate compartments
  • As these compartments change in size, the ligaments separating the compartments become more evident and a smooth, rounded youthful appearance transforms into a multicontoured aged face

Subcutaneous fat compartment

Treating the aged face

  • Gender differences
  • Racial differences
  • Assess properly
  • Counsel patients
  • Pictures and consent forms
  • Body dysmorphic disorder
  • Discuss costs and anticipated results- never overcommit
  • Treat skin, subcutaneous layer, muscle etc

Creating a roadmap

  • Analyse & Align
  • Prioritise & harmonise
  • Sequence procedure to create incremental and exponential results
  • Soft neutral aesthetic appeal

Changes in 40’s to 50’s

  1. Malar fat pad descent
  2. Nasolabial fold
  3. Early labiomandibular line
  4. Early loss of definition of jawline
  5. Worsens in the 50s-60s

Beyond 60’s

  • Deficient lower one third
  • Poor bone support
  • Excess soft tissue
  • Attenuation of ligaments
  1. Ptosis and deflation of midface
  2. Jawl
  3. Short chin

Areas where we need to focus on

  • Forehead
  • Upper eyelids
  • Tear trough
  • Nasolabial area
  • Jawl
  • Neck

Ageing of the neck

  • Forehead
  • Upper eyelids
  • Tear trough
  • Nasolabial area
  • Jawl
  • Neck

Lip Ageing

  • Upper lip length increases by 1.4mm
  • Upper lip thinning by 1.4-3.6mm
  • Lower lip- loss of volume/ proportion



  1. Both UVB and UVB protection
  2. At least 30% minutes before sun exposure and reapply regularly
  3. SPF 50+
  4. Types or sunscreens

Retinol creams

  1. Retinoids reduce fine lines and wrinkles by increasing the production of collagen
  2. They also stimulate the production of new blood vessels in the skin, which improves skin colour


  • Vitamin E- no proven efficacy
  • Vitamin C- Topical applications can improve pigmentation

Dermapen & Laser treatments


Laser treatments

Carbon dioxide lasers

The gold standard of all lasers is the Carbon dioxide laser. It can be used for various purposes treatments:

  1. Acne scar removal
  2. Smoothen burn scars and surgery scars
  3. Skin resurfacing
  4. Wrinkle improvement, skin rejuvenation
  5. Skin tightening
  6. Improving pigment, age spot, sun spot, freckle
  7. Sun damage recovery
  8. Improving texture tone, pore size and treat telangiectasias

Fractional laser

Dermapen vs Laser treatments

  • The treatment objective for both microneedling and fractional laser is to create micro wounds. This will result in a cascade of biochemical processes following a trauma. Thus, it will start with the inflammatory stage, releasing growth factors. Following are the proliferative stage and then the remodelling stage. This leads to the stimulation of neocollagenesis and formation of a tighter collagen matrix, a younger looking skin.
  • With micro-needling you puncture the skin and then remove the needle again, causing micro-cuts. Whereas with fractional laser you cause coagulation and/or vaporization of a part of the surface you treat. This distinction is important to understand. With microneedling the body will respond by healing the micro-cuts and with fractional laser the body will build new tissue to fill up the ‘channels’ or ‘wells’ where you have destroyed the tissue.