Management of the Lower Third of the Face and Neck

Face-lifting has evolved for well over a century. Attempts to improve the quality and longevity of results have ushered in alterations of incisions, extent of cutaneous undermining, manipulation of the superficial muscular aponeurotic layer, and treatment of the platysma and neck tissues.

It was not until the second half of the last century that surgeons began addressing issues other than tissue excess and sagging. By the 1960s, wrinkled skin began to be treated with chemexfoliation. Dermabrasion was also used to smooth wrinkles. It took another 30 years before light-based tools were promoted for skin exfoliation. After the initial surge in laser use, chemical peeling regained substantial popularity.

In the first decade of the new century, surgeons began to aggressively deal with age-related midface deflation. At first, there was high interest in attempts to lift the midface. Although some surgeons remain proponents of midface-lifting, by 2007 many began to recognize the possibility of improving facial deflation with large-volume replacement fillers.

As techniques have evolved, so has our understanding of the facial aging process. It is now clear that there are three general categories to address regarding facial aging: sagging and tissue excess, wrinkling and skin deterioration, and volume loss. Each category may need to be addressed by different treatment modalities.

Sagging can be improved in many cases with the numerous excellent surgical approaches. Wrinkles, surface irregularities, and pigment changes can be addressed with resurfacing techniques such as laser or chemical peel. Volume loss can be restored with a growing list of injectable fillers as well as fat and stem cell injections.

Facial aesthetic surgeons have never before been able to improve the aging face to the extent possible today. The techniques, tools, and products continue to evolve and improve. This is what we will discuss in this issue of the journal. We have tried to include state-of-the-art approaches that address sagging, wrinkling, and volume loss or insufficiency. We will present the tired-and-true as well as the new, but this is an ever-changing field.