By Dr. Kimberly Finder
Every day patients and friends ask me what they should do about their faces. They feel they’re looking older and have lost their youthful look. Today, we have options like Voluma® or Sculptra® which can replace a facelift. But when asked about what someone should do about their face, whether they will need a facelift is at the heart of what I tell them
One of the most important things I look for is this: Is this person a Sinker or a Sagger? That decision is crucial.
Face Shape and Contour
The ideal face shape is an upside-down egg. The upside down egg has its greatest width at the area that corresponds to our temple/upper cheek region with a taper to the narrowest width at the area that corresponds to the chin. The underlying structures that create this ideal shape are the boney foundation, the overlying muscles, and structural fat pads that give our face a cushion. I’m not talking about having a “fat face,” but rather the fat that is necessary to cushion our faces.
When we’re young our face looks ideal. But as we age, we lose bone mass in our faces just as we lose bone mass in our other bones. The fat pads shrink and our muscles aren’t as toned as they used to be. The upside down egg can begin to look like a peanut. All these changes occur to a greater or a lesser degree in each one of us. With a significant degree of bone, fat and muscle loss our faces will look like they are sinking. Our aging is primarily making us look like a Sinker. Not everyone will obviously “sink,” however.
The state of our skin plays the biggest role in determining if we are going to be Saggers as we age. As we age we lose collagen and elastin in our skin. These two proteins play a vital role in our skin elasticity.
We can see the diminished health and decrease of important structural support proteins in one of two ways. Sometimes the skin will get thinner and thinner, although it may not be droopier. This thinner skin may redrape over the shrinking of the underlying bone, fat, and muscle and increase the Sinker appearance.
In some people, the skin doesn’t look thinner, but it gets droopier. Instead of sinking with the underlying tissues, it can actually look like there’s too much skin. The underlying muscle and tissues also may look like they’re getting droopier as well. The soft tissues (muscle, connective tissue, and skin) look like they’re heading south, rather than shrinking and sinking. This is the classic appearance of a Sagger.
So are you a Sinker or a Sagger?
Sinkers have better elasticity and the skin redrapes over the lost facial volume. They begin to look sunken and even gaunt, especially the temples under the cheekbone. (see photo) Their major problem is volume loss. A facelift for a sinker will do them no good and actually can give them unnatural look. They need to replace the lost volume using fillers and volumizers. In my experience, there are more Sinkers than Saggers.
Saggers have loose skin and can appear to have too much skin. Just replacing the volume will not improve their appearance because it takes too much volume to make up the slack. A facelift can remove the extra skin. After a facelift, a Sagger may begin to look like a Sinker, and will then need fillers and volumizers. Filling and volumizing before a facelift is not a good strategy.
Everyone ages. Luckily, there are more options today. Knowing whether you are a sagger or a sinker is critical to knowing your options. It is impossible to make the face of someone in their 50s look like the face they had in their 20s, but it is possible to create a natural looking rejuvenated face.
Dr. Kimberly Finder has specialized in aesthetic dermatology since 1996. Her expertise includes tumescent liposuction and facial rejuvenation. Her practice is The Face and Body Place which is located at the corner of Bitters and Blanco. (210) 492-3200.