A multitude of aesthetic procedures target saggy, wrinkled facial skin. But research published in the Journal of Plastic and Reconstructive Surgery gives an insight into the changes to the jaw bone that occur during ageing.
      A collection of 120 facial CT scans, taken for unrelated medical reasons, were reviewed for changes over time to the facial bones. The scans were divided by gender and age into three age groups: ages 20–36; 41–64; and 65 and older. Read more >>

Practitioners will benefit from an understanding of exercise physiology and how athletes can tailor their training to achieve optimal results, writes Dr Rohit Kotnis.
       Exercise physiology studies how the human body copes and adapts during physical exercise. Exercise represents one the highest levels of stress to which the body can be exposed—the effects on organ function can be significant during both short, high-intensity exercise, as well as prolonged strenuous exercise.
      During exercise and physiologically stressful conditions, a number of changes take place. The liver responds by producing additional glucose. The increased cardiovascular activity of the heart and improved respiratory efficiency allow for an increased supply of oxygen.
      During prolonged and strenuous exercise, plasma blood glucose can be reduced which may, in the extreme, lead to a hypoglycaemic state. Dehydration is another common problem, as are low plasma sodium blood levels. Read more >>

Devices for injecting while regulating the flow of fillers are starting to come on stream.
Dr Sabine Zenker assesses their role in the aesthetics market and puts one to the test.
      The focus on filling and volumising treatments has been to choose better products with enhanced efficacy and safety. While improvements to their composition will continue, the development of new methods of delivering fillers such as hyaluronic acid will represent a big step forward for physicians and their patients.
      Patients’ satisfaction of HA-based injections depends on two major factors: the nature of the product and how it is administered. Pain and bruising are the most commonly reported untoward events, even in the most skilled hands. Read more >>

Threads for facial work have had adverse publicity from some quarters. In a master’s hands they are a good alternative to surgery, lasting two to three years. Dr Luiz Toledo describes his technique.
      When endoscopic surgery began in earnest in the early 1990s, it made us look at facial rejuvenation differently. Until then, the only minimally invasive procedure for the face was liposuction. The rhytidoplasty and blepharoplasty techniques had been, with few modifications, used for more than 50 years.
     Techniques that use long incisions expose vast subcutaneous areas and allow for the removal of all the excess skin and fat of the face. But patients aged 35–45 typically do not feel they are ready for long incisions and want new ways of improving their looks.
     The endoscopic technique was conceived to improve the forehead and the glabellar regions. Later we used it to improve and elevate the mid-face and the neck. This required a new kind of suture—one that could be placed through the endoscopic incisions.

A combination of treatments is how Dr Aamer Khan attains the desired stage of atrophy hypertrophy, a model describing the physical, anatomical and physiological changes in the face as it ages.
     Historically, medicine has looked at the ageing process from a gravity model and many surgeons still do, but paradigms are changing. To understand ageing, we need to start studying what we see in nature around us. For example, we distinguish fresh from old fruit by its texture and appearance.
     Atrophy hypertrophy is a new model that describes the physical, anatomical and physiological changes that occur in all structures of the face as it ages. These structures include changes in the structure of bones, muscles, fascia, soft tissues and fat, and the skin. It changes our paradigm from a purely gravitational shift model to a three dimensional anatomical model that looks at the changing volumetric balances of the face and the body. This then allows us to plan for a more natural reversal for facial and body rejuvenation surgically and non-surgically. .