Isn't it surprising how some people appear to age noticeably in a short time while others look more youthful from year to year? What is their secret? So-called liquid facelifts provide a nonsurgical alternative to implants, incisions and recovery time.

Anatomy of Aging

As the face ages, it loses volume. This causes shifts in the youthful contours and prominent landmarks of the face. Loss of facial fat, muscle, bone and skin elasticity lead to nasolabial folds, marionette lines, jowls and wrinkles around the lips.

Redistribution of maxillary and infraorbital fat pads also occurs with aging. The complex array of muscles supporting the facial dermis and adipose tissue undergo a similar reduction. It is speculated that the thinning, sinewy facial muscles are more visible due to losses of overlying tissue and appear to cause increased facial expression due to greater radiation of expression lines with movement.

The source of surprisingly substantial volume loss is bone loss around the eyes, teeth, maxilla and jaw. The pattern and speed of bone recession is dictated by genetics and environmental factors.

Volume changes in soft tissue and skin contribute to the visible changes of aging. The craniofacial bones change, and the overlying soft tissue repositions and loses volume. The face shrinks, and the overlying skin becomes too big for the face, resulting in wrinkles, folds and sagging. The overall shape of the face changes from plump and heart-shaped to a triangle with a widening at the bottom and a hollowing of the upper and mid face.

Patient Presentation

Candidates for a liquid facelift usually present with a complaint of looking tired. They point to wrinkles, loose skin and dark circles under the eyes and around the nose. Some fear that treatment may change their appearance or look artificial. Although the skin appears tighter after facelifts, balance and youthfulness can be lacking due to volume loss. The goal of volume replacement is to help patients appear more youthful. Restoring youthful volume can help patients look more like they did 10 to 15 years ago, not make them look like someone else.

The term "liquid facelift" refers to treatments that can be performed using injectable therapies that require little or no downtime. Some preparations work on underlying muscles by relaxing them, softening wrinkles or appearing to lift certain areas of the face. Other therapies add volume.

Liquid Facelift Choices

Botox relaxes dynamic muscles that create wrinkles as they contract. Areas that can be treated with Botox include crow's feet, frown lines, forehead lines, neck lines and chin dimpling. It can elongate the appearance of the chin in certain patients, creating a more continuous appearance of the jawline. Botox can help elevate the corners of the lips, enhancing a patient's smile. A small amount injected into the lip border reduces the appearance of lip lines and can actually help the lips appear more plump.

Botox injection is the most popular nonsurgical cosmetic procedure today. Improvement of wrinkles may last up to 4 months. Until recently, Botox was the only botulinum toxin A preparation with a cosmetic indication. Dysport, the first competitor with similar indications, was approved in April.

Tissue fillers are another group of injectables used for liquid facelifts. The most commonly used are Restylane, Perlane, Juvederm, Cosmoderm and Radiesse. Not all products can be used anywhere on the face. Depending on the patient's appearance and the treatment location, one or a combination of these products can be used to reduce the appearance of wrinkles and provide plumping of various facial structures. Hollowing under the eyes, mid face, temples and chin can dramatically improve with volume. Cheeks can be enhanced to return that heart-shaped youthful face and to lift the nasolabial folds. Nasolabial folds and marionette lines can be treated with tissue fillers, as can the jawline and hollowing of the cheeks. Treatment of the eyebrows can lift the eyelids and enhance eyebrow shape.

Sculptra exists in a category called collagen stimulators. It can be used to volumize most areas of the face. Sculptra works by stimulating the body's natural collagen, which helps smooth out lines and wrinkles. It provides a long-lasting natural appearance.

Facial Balance

Facial balance can be returned using a combination of the products discussed in this column - without surgery. These products require just a few minutes for treatment with little to no downtime. Patients do not appear to have had "work done." Rather, they appear refreshed.

Mina Grasso is an adult nurse practitioner who owns Allure Image in Upland, Calif.