SURGERY FOR THE AGING FACE
Aging changes in the face do not occur suddenly - they evolve slowly and involve different regions of the face at different stages. Improving appearance surgically often requires a series of planned operations designed to forestall the inevitable signs of aging rather than one major all-encompassing operation. For example, the earliest signs of aging generally become apparent around the eyes as the eyelids become baggy, "crow's-feet" form, and upper eyelid skin and eyebrows tend to sag. When adequate rest no longer diminishes these changes, the time has arrived for correction of baggy eyelids and drooping brows - often the initial operation necessary to improve appearance in an aging face. In some families these changes become troublesome in the mid-twenties or early thirties.

Aging changes in the face proper generally occur later as elastic tissue decreases and facial bones and skull actually thin and become smaller. The overlying skin "envelope" thereby becomes excessive and creates skin and muscle sagging and pouching along the jaw line ("jowls"), under the chin, and at the corners of the mouth. Gravity exaggerates these changes and leads to a "tired" look when the patient actually feels vigorous and healthy Currently patients no longer need to wait until hanging folds or almost irreversible changes of aging have occurred to seek improvement. Improved operations have shifted preference for corrections to the late forties (or earlier in some circumstances), when planned limited corrections can often be made to maintain a youthful appearance for an extended time.

The final surgical results are almost always better when aging skin problems are corrected at an earlier age.