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Why facial ‘scaffolding’ is key to maintaining a youthful look

It’s not just what’s on the surface, but the muscle, fat and bone our skin is draped over that helps us appear more youthful

If, like me, science and physiology were not your strong suit at school, then helpful comparisons are often welcome when it comes to understanding the internal workings of the face and how it ages.

Case in point: there’s one comparison now used so commonly in the world of aesthetics that it has become a term on its own, and with good reason. Scaffolding – and indeed re-scaffolding – perfectly explains why treating the visible signs of ageing alone is not enough to help you retain a youthful-looking visage.

It’s the structure underneath that literally holds everything in place while creating shape and contours, which needs care and attention too.  

“Scaffolding refers to the bone, deep fat pads and superficial fad pads which are the main structures underneath the skin that change as we age,” explains Dr Raquel Amado, EV Expert and Director at Dr Raquel Skin & Medical Cosmetics.

“As clinicians, we need to find ways to facilitate patients' understanding of medical jargon. With this terminology they can fully understand how we age, how the deep structures of the face play a big role, and in terms of treatment, what we are proposing to them. As Dr Lee Walker [renowned aesthetics clinician and industry advisor] says, ‘bone sets the tone’ and this is where it all starts."

Structurally (un) sound

Just as superficially, texture and tone are affected over time, there are unavoidable changes happening deep down, too. “In simple terms, things shrink and lose density,” says Dr Amado. “The bone reabsorbs, the deep fat pads also reabsorb and with the superficial fat pads, some get smaller, some get bigger and they will also change position. As this happens to the face’s scaffolding, just like a balloon deflating, the visible changes you will see are nasolabial folds, marionettes lines and jowling.”

Our dwindling collagen stores are also to blame, points out Dr Ioannis Liakas, EV Expert and Medical Director at Vie Aesthetics. “As we age, we lose fat under our skin,” he says. “But in addition to this, the amount of collagen we naturally produce reduces significantly and this causes skin to become less firm and the face to appear hollow or saggy.”

Shaping up, inside…

Thankfully, when scaffolding does come down, there are ways to rebuild it again. This is where injectable and non-surgical treatments that put support back in place, come into play.

“Re-scaffolding refers to the restructuring of the face and rebuilding of the key collagen structures beneath the skin,” explains Dr Liakas. “It can help people who have sagging or loose skin because it reinstates those collagen structures. Results vary between the individual and the treatment, however you will notice that the skin is tightened and the structure of your face appears lifted, which can have positive effects on the rest of your facial features too.”

To achieve this, Dr Liakas suggests thread lifting with threads made from polylactic acid, such as those from Silhouette and or Definisse, which he uses in-clinic. “This type of thread is slowly and naturally absorbed into the skin after application,” he says. “The process triggers your collagen cells to produce even further collagen and help restore lost volume.”

Dr Amado agrees that replacing lost volume is at the heart of re-scaffolding faces that look deflated due to age. “For me, dermal fillers are the best way to address this, and I personally use Neauvia and Teoxane,” she comments. “The best areas to inject are where the changes happen, taking into account how people age individually. But common places are temples, cheeks, next to the nose, in front of the ear, corner of the jaw, chin and the pre-jowl area. Everyone who has started seeing the signs of volume loss will benefit and if the correct approach is taken, you will look fresher and younger.”

…and out

Once your scaffolding is back in place and skin is well positioned and supported, it makes sense to further improve benefits with treatments that work synergistically on the outer layers of skin, such as re-surfacing lasers or tightening radio frequency.

“Skin tightening treatments like Morpheus8 are renowned for prompting collagen production and delivering long-lasting, continuously developing results,” enthuses Dr Liakas. “It’s a skin-remodelling treatment that incorporates elements of resurfacing combined with radio frequency. Resurfacing treatments cause artificial injury to the skin so as a natural response, the body is prompted to produce collagen for repair. Such treatments go hand-in-hand when combined with a great medical grade skincare routine.”

At home, Dr Liakas recommends using products containing hyaluronic acid, peptides and retinoids to maintain the steady and natural production of collagen beneath the skin. It’s a multi-layered way of approaching an issue of multiple, structural layers and one that Dr Amado also recommends.

“I always say a 360-approach is when you get the best, long-lasting results,” she adds. “Because the skin is often also aged with pigmentation, fine lines and wrinkles, a combination of treatments and home care to rejuvenate the skin will make patients look younger and give better outcomes.”

Time to put the scaffolding back up…

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