World renowned cosmetic surgeon Dr.Vijay Sharma - A specialist in Facelift,liposuction,breast augmentation,buttock lift,Hair transplantation

NATURAL FORCES

      First, there are the creases that already exist in the make-up of our skin. They are not strictly caused by the aging process; they are present from birth or show up soon after and only become more pronounced with the years. Example: the lines in the folds of the neck, which may number from one to three. These kind of lines are known as orthostatic lines and they are present in those areas where an excess of skin is required for purposes of flexion and extension. _____Then there are the dynamic lines , formed by 'dynamism' - the repetitive right angle pull exerted on the skin by the muscles of expression. The first such lines to appear are the horizontal wrinkles of the forehead and they begin to set in as early as the teenage years. They may vary in number and position, but once they have developed, they tend to progressively increase in depth, until eventually they become evident even in repose.
      The next lot of dynamic lines to set in are the "crows feet" or "laugh lines" - the fan-like wrinkles of differing length that radiate outward from the eyes. They are caused by the interplay of the muscles in this area - so, the more you use your eyes for expression, the greater the eventual depth of these lines which usually begin to appear in the twenties.
      Another example of dynamic lines are the frown lines (vertical lines between the brows) which can vary in number from one to three. Two other commonly found dynamic lines are the smile lines - that is, the lines around the mouth which usually appear in the 30s - and the fine lines just above the mouth which generally do not become visible until the age of forty or even later.
      Gravitational lines are the ones that creep up on you most insidiously of all. They are the outcome of the forces of gravity and usually become evident after the age of 40. As a result of the loss of the underlying fat pad in the face, the atrophy of the facial skeleton, the dynamic furrows that have already formed and , finally, any loss of teeth that may have occurred, you are left with a loose, unpadded skin covering which falls in sagging folds entirely at the mercy of gravity. By the late '50s, the lower third of the face virtually collapses.
      Gravity works its devastation all over the face. Both, upper and lower eyelids become horizontally redundant, falling in loose, downward folds. At the same time, the underlying layer of fat protrudes, reinforcing the look of bagginess or puffiness around the eyes. The fat underlying the cheekbones is gradually lost, causing the cheeks to become sunken, and the skin to hang in redundant vertical folds, forming the typical "jowls". Additional vertical lines eventually form all over the face and neck.
      In the neck area, gravity works so as to deepen the horizontal orthostatic lines (described earlier) as well as to form vertical folds. Especially in men, this is followed by additional interlacing lines, bringing on the characteristic "leatherneck" appearance.
      The fat loss occurring in the area below the chin, combined with the pull of the underlying muscles, produces two long vertical "turkey gobbler" folds. On the other hand, in some people there is a familial tendency to run to excessive fat in this region, resulting in a double chin.
      Some changes in the face as we age are produced by the simultaneous interplay of two different forces. Thus, in the case of the so-called "nasolabial folds" - the deep lines that run from the nose to the mouth-the effects are wrought by both, dynamic and gravitational forces, working together. Eventually these lines may become quite deep in repose. It is the penalty we pay for our standing posture.

THE ULTRA-VIOLET RAYS OF THE SUN

      Apart from the "natural" forces acting on the skin throghtout your life, there are also the external agents that cause degenerative changes in the skin. These include such elements as the wind, the cold, and, most of all, the sun.
      The Ultra violet (or UV) rays of the sun are today thought to be the prime culprit behind wrinkles and the loss of skin tone, especially on exposed areas like the face, the neck and the hands. The damage caused by the ultraviolet spectrum (UV-A, UV-B and UV-C) is cumulative. Most of it is thought to occur by the time we are about 20 years old, although it may be a decade or more before the effects start becoming evident.
      UV causes damage to the skin's supportive network, the collagen and elastic fibers that lie in the lower layer of skin (the dermis) and give it its elasticity and tensile strength. The tone of the skin is gauged in terms of the "rebound phenomenon" - that is, how quickly the skin returns to its original shape after being stretched. This tone, or elasticity, lessens with age, particularly on exposed areas.       You can see the difference between the skin on exposed and unexposed areas with your own eyes. Compare the skin on the face of a 50 year-old woman with the skin on her thighs or buttocks: there is more obvious sagging and wrinkling in the former. Scientific studies have confirmed this difference: the collagen is more resistant in unexposed skin than in exposed skin in the same person; there is virtually no thinning of the epidermis (upper layer of skin) in parts like the buttocks compared to serious thinning of this layer in the face Etcetera. Damage to the skin has been noted in people as young as 25 who have had heavy sun exposure. Also, when sun-damaged skin from an exposed area was transplanted to unexposed areas, it showed a partial improvement in texture.
      In most of us, however, the effects of the sun are insidious. We don't notice the process at work until suddenly, in the third, fourth or fifth decade of life-depending on how much sun-worshipping we have done, we are rudely presented with the effects of the cumulative damage - a fait accompli.
      Darker-skinned people have somewhat more natural protection against the sun's rays; This comes from the larger number of melanin pigment granules that their skin cells have: this pigment absorbs and disperses incoming UV rays, so that fewer of them penetrate to the lower layer of the skin.
      The sun apart, other agents in the external environment, industrial pollutants for example, also affect the skin adversely. Metal ions such as cadmium, lead and copper , lead to destructive changes known as cross-linkage - the forming of new bonds between protein and protein, protein and lipid (fat), lipid and lipid. Cross-linkage causes a loss of elasticity. It's the same process that is at work in tanned leather or brittle rubber, for instance. In the skin, potent cross-linkers include the ozone in smog, the lead from canned food and car exhausts (where petrol is used) and the aluminium from cosmetics which contain it.

GENETICS

      The rate at which your skin ages has, to a large extent, already been printed into your genes - in terms of whether your skin is thin and dry or thick and oily (the former ages faster), whether you are light-or dark-skinned (darker skins, as we have explained earlier, resist the sun's UV rays better than lighter skins), even whether you have high cheekbones or not (faces with high cheekbones age more slowly).
      Specific aspects of aging in the face and neck area also appear to show a familial influence. Thus, the tendency to develop a double chin - which is not necessarily related to overall obesity - seems to run in some families.
      The genes also play an important role in the development of "crow's feet", the lines around the eyes that are more pronounced in those who are very expressive with their eyes: 'laughing with the eyes' may be a family trait.
      Naso-labial lines may also be hereditary.

LIFESTYLE HABITS

      The habits that we develop, take their toll on the skin in the long run. They include squinting into the sunlight (which contributes to wrinkling around the eyes), scrunching your face into your pillow when you sleep (which, over a lifetime, will contribute to the naso-labial lines - they will run deeper on the side you sleep on) and yo-yo dieting where the repeated cycle of weight gain and weight loss wears down the skin's supporting fibres.
      Two other lifestyle culprits are alcohol and smoke. Both wreak skin damage on several fronts. Alcohol causes, among other things, cell dehydration and also a depletion of vitamin C, the latter resulting in a fall in the production of collagen.
      Smoking adds years to your looks (though not to your life). A 1995 study in the U.S. of over 1000 men and women showed that the risk of facial wrinkling was two to three times greater among smokers than among non-smokers - though the effect of smoking on the face does not become evident until after age 39. (The study controlled for other wrinkle-promoters such as sun exposure and weight loss).
      How does smoking cause wrinkles? Most probably through a combination of effects: it's known that smoking decreases blood flow to the skin. Toxins like Benzopyrene in tobacco smoke destroys vitamin C, causing a drop in collagen production - in the same way that alcohol does. The acetaldehyde in smoke is a deadly cross-linker. The carbon monoxide severely curtails cell respiration by combining with oxygen in the red blood cells. Finally, there's the exposure to the drying, irritating effects of smoke.

THE DEGENERATIVE PROCESS

      While all the above agents and processes are at work, there is one underlying ongoing process which will cause all skins - exposed or non-exposed, abused or nurtured - to degenerate slowly, but inevitably. This is what is known as "chronological" or intrinsic aging: the biological decline that is responsible for the run-down effects that come on as birthdays pile up - from skin wrinkles to organ failure.
      There are several theories about why the human body ages, but we needn't go into them here. As far as the skin is concerned, we can list what happens:
• As we grow older, there is less new collagen ("soluble collagen") being formed and correspondingly more mature collagen ("insoluble collagen") hanging around. This mature collagen is tougher than new collagen - which means it is less elastic.
• With age, there is also a loss of the so-called "ground substance" (in which the collagen and elastin fibres lie). Nutrients must pass up through this ground substance to reach the skin cells, and its loss therefore affects cell nutrition and cell function.
• After the age of 50, there is a marked decline in the activity of the sebaceous glands which produce the sebum (a semi-liquid oil) that lies in a protective film over the skin, delaying moisture loss and keeping the skin smooth. The outcome of this shortfall which is more marked in women than in men: drier, flakier skin as the years roll by.
• After age 40, the rate at which dead cells are shed from the surface of the skin slows down. Because of these clumps of dead cells hanging around, the surface of skin begins to look dull.
• Some sweat glands are totally destroyed with age; others atrophy. Since the urocanic acid present in sweat provides some protection against UV rays, there is less of this protection with the sweat slowdown.
• Also declining in number, by the 40s, are the pigment granules that are the skin's primary defence against UV radiation.
•That's not all. After the mid-30s, bone is being torn down faster than it is formed, all over the body. In the face, the decline in the supportive bony skeleton (coupled with any loss of teeth that may have also occurred by this time) translates into sagging of the skin.
      There are very many other degenerative changes occurring in the body that have an effect on the health and, therefore, the appearance of the skin. Together with the multi-pronged attack by the other provocateurs discussed earlier, they wreak the slow-motion effects that will eventually transform even a Mona Lisa face into a Dead Sea scroll.
      The bad news is that there is very little we can do today to reverse such skin damage once it has occurred.
      The good news is what this book is all about. If you're 50, there's nothing that can make you look 20 again. But there's much that can be done to turn back the clock, to restore attractiveness and, in the process, self-esteem. Not just for the aging face, but even for the young face with less-than-perfect features (a hooked nose, a receding chin), there is today an endless array of cosmetic surgery options-from chemical peels to smoothing out fine wrinkles, to implants to creating high cheekbones. Considering the face alone, as a whole or in its various parts, there are about 50 different cosmetic surgery procedures that can be carried out to put back what Time took away, or to put in what Nature forgot.
      So, stop looking into your mirror in disgust - and start looking at the boundless possibilities that now exist. Not only for your face, but for virtually every body part. Beginning over.

HOW WE LOSE FACE VALUE
      That seventeenth-century lament finds an echo, both, before and after Ninon de Lencles' age. One of Time's cruellest jokes is that not only wrinkles, but the whole grab-bag of horror tricks - bags, sags, pouches, blotches and blemishes - that Time plays on our skins, appear first and worst on that part, which we present first, and most, to the world: our faces.
      To most of us, caught up in the business of living, the realisation comes on suddenly. One morning, looking in disbelief into the bathroom mirror, you find IT HAS HAPPENED. That familiar friend - the smooth, glowing, even-toned, face of your youth is no longer looking back at you. In its place you see a tired, dull, lined visage with smile lines, crow's feet, forehead furrows and - help! - a jawline that's beginning to fall down.
      What's been happening while you were looking the other way?
      Actually, it's been happening since the moment you were born. That's true: aging of the skin begins from zero-hour, and continues right through life.
      There are different aggressors at work here; and there are several reasons why your face receives the brunt of their attack. Understanding the forces that are wreaking this skin damage will help you understand which cosmetic-surgery procedure/s are best suited for your face.