Facial rejuvenation is a broad term that relates to restoring facial structures to a more youthful appearance. Generally, facial rejuvenation is categorized as non-operative or operative.
A thorough preoperative assessment and understanding of patient desires are important in order to optimize outcomes and to create realistic expectations of various treatment modalities. As with any initial patient encounter, a comprehensive history and physical should be performed. Since facial rejuvenation is performed electively, patients with significant comorbidities such as smoking, diabetes, and clinically significant bleeding states should be excluded in most circumstances. A basic psychological assessment that evaluates a patient's motivations for surgery should also be obtained. Adequate time should be allowed for questions and decision making focusing on the patient's specific concerns. Some plastic surgeons also incorporate the use of photographic software that can simulate the effect of specific procedures.
Skin quality is often the first characteristic that is noted on
consultation. The general quality of the skin, including elasticity,
wrinkles, and actinic damage is assessed.
It is beneficial to divide the face into thirds when examining
a patient so as to systematically evaluate the entire face. In the
upper third, or the periorbital zone, the forehead, brow, eyelids,
and upper midface are evaluated. A complete investigation
must include brow position, forehead height, glabellar creases,
excess skin or wrinkles (crow’s feet) in the temporal region and
in the upper and lower eyelids, and evaluation of the lateral
canthal position and lower lid tone. The middle third , or perioral
zone, is generally referred to as the lower face; an examination
includes the nasolabial folds, the angle of the mouth, the upper
and lower lips, chin, nose, and ears. Evaluation of the lower third
of the face, the neck zone, includes an assessment of the neck
with regard to platysmal banding, excess skin, as well as the
jawline, submandibular gland, and digastric muscles.