EVALUATION

AF Facial Aging Education Assessment Regions Planning References

Clinical teaching resource

Evaluation of the Aging Face Facial Aging Review AAO EyeNet Resource Teaching Resource 01 Teaching Resource 02 Teaching Resource 03

A structured approach to facial ageing assessment, integrating skin quality, soft-tissue descent, volume loss, muscular activity, skeletal remodeling, and periocular function.

Presented by Dr Sneha Karvekar  •  Dr Rohit Rao

Comprehensive assessment

Facial ageing is evaluated layer by layer.

An effective assessment identifies aesthetic concerns, functional deficits, anatomical changes, and the appropriate treatment pathway for each patient.

01

Skin Changes

Assess fine lines, pigmentation, texture, pore visibility, photoageing, skin elasticity, and overall cutaneous quality.

02

Volume Loss

Identify temporal hollowing, tear-trough deepening, midface deflation, pre-jowl sulcus formation, and loss of structural support.

03

Tissue Descent

Evaluate brow position, upper-lid hooding, malar descent, cheek flattening, lower-face laxity, and jawline contour changes.

04

Skeletal Remodeling

Consider orbital enlargement, maxillary and mandibular support changes, and their impact on the soft-tissue envelope.

Regional examination

Assess each facial zone independently and as a connected unit.

The upper face, periocular region, and midface require focused examination because changes in one zone can influence the perceived age and function of another.

Zone 01

Upper Face

• Horizontal forehead lines
• Glabellar or frown lines
• Brow ptosis and brow-arch flattening
• Temporal hollowing
• Reduced skin elasticity and thinning

Zone 02

Periorbital Region

• Dermatochalasis and upper-lid hooding
• Lower-lid bags from fat prolapse
• Tear-trough deformity
• Periorbital hollowing and crow’s feet
• Ptosis, lid laxity, or scleral show

Zone 03

Midface

• Malar fat-pad descent
• Flattening of cheek prominence
• Midface volume loss
• Deepening of nasolabial folds
• Increased infraorbital hollowing

Volume loss & treatment planning

Treatment planning begins with a detailed diagnosis.

The goal is not simply to treat a line or fold. The plan should address the underlying structural changes while preserving facial identity and function.

Volume-loss assessment

Evaluate the face in neutral expression, dynamic animation, frontal, oblique, and profile views.

1. Temporal hollowing
2. Periorbital fat loss and tear-trough depth
3. Midface volume loss and cheek flattening
4. Pre-jowl sulcus formation

Common treatment modalities

Treatment is individualized based on anatomy, patient goals, ocular function, skin quality, and the degree of ageing-related change.

• Skin-care optimization and photoprotection
• Neuromodulators for dynamic facial lines
• Biostimulators, PRP/PRF, chemical peels, laser and RF treatments
• Dermal fillers or fat grafting for selected volume deficits
• Thread lifts or surgical procedures for indicated tissue descent

Non-surgical Neuromodulators, peels, laser resurfacing, RF tightening and skin-care protocols. Volume Restoration Targeted fillers, biostimulators, PRP/PRF, or fat grafting where appropriate. Surgical Blepharoplasty, brow lift, ptosis correction, lower-lid support and facial rejuvenation surgery.

Periocular assessment is essential.

In patients with ageing changes around the eyes, evaluate eyelid function, lid position, ocular-surface health, brow position, visual consequences, and the relationship between volume loss and lower-lid support before planning treatment.

Suggested reading

References

Core academic references for understanding periorbital ageing, facial-skeleton changes, and oculoplastic surgical assessment.

1. 1. Lambros V. Observations on periorbital and midface aging. Plastic and Reconstructive Surgery. 2007;120(5):1367–1376.
2. 2. Mendelson BC, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic Plastic Surgery. 2012;36(4):753–760.
3. 3. Shaw RB Jr, Kahl R, Katzel EB, et al. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plastic and Reconstructive Surgery. 2011;127(1):374–383.
4. 4. Nerad JA. Techniques in Ophthalmic Plastic Surgery: A Personal Tutorial. 2nd ed. Elsevier Saunders; 2018.

Educational use only: Clinical decisions should be made after a complete individual examination and appropriate informed consent.

© Evaluation of the Aging Face