Dr. Joseph Hkeik
When looking to treat the visible signs of aging, many women turn to treating wrinkles as the primary factor. But what they don’t know is that the physiology of aging reaches much deeper. We spoke to anti-aging expert Dr. Joseph Hkeik to find out what the underlying causes of visible aging really are.
According to Dr. Hkeik, the aging process, particularly in the face, is very dynamic and the conversation we should be having is about volume and contours.
The process begins in the outer skin layer, which becomes thin through loss of elasticity and collagen. Below that we have the fatty layer of the face, which shrinks with age, becoming smaller and thinner. This contributes to the sagging and shadows we see on skin over time. Below the fatty layer we have the facial muscles, which eventually lose their tone and sag. And deeper below this, we have the boney layer, which, surprisingly, also loses its contouring and density, becoming thinner over time.
‘All this together will create loss of volume in the face and sagging of the skin on the face.’ Says Dr. Hkeik.
Although loss of volume will happen at different stages for different people, it will usually occur in certain parts of the face before others from early to mid 30’s. When asked about the common areas of concern for visible aging, Dr. Hkeik says that people experience the most significant loss of volume around the temples, under the eyes, cheekbones and the lower third of the face, or ‘marionette’ area.
‘Most people notice that temples become hollow, the cheekbone area will lose it’s contour and become a bit flatter, you’ll get hollowing under the eyes. Go a little bit below that and further towards the chin you’ll notice that people will lose volume from the lower third of the face, and I’m referring to the ‘marionette’ area, where people start to notice shadowing.’
According to Dr Hkeik, volume equals youth and it is these factors when combined that contribute to the most obvious appearance of aging.
But adding volume doesn’t mean making the face look fat, as some believe. As a preventative anti-aging step, adding volume to your face should be about contouring; adding volume to the parts of the face that have lost fullness.
‘It’s a genuine concern. I think adding volume should be all about adding volume where the patient has lost [it]’.
These areas are most commonly the temple, which is contoured ‘not to make it fatter, to make it chiseled’, cheekbones, mid-face ‘to support the skin and hydrate the skin, rather than to change someone’s look’ under eyes ‘to get rid of the tired look’, the ‘marionette’, the jowl and the nasolabial fold.
So when should we begin addressing loss of volume? Dr. Hkeik says this is different for everyone, but recommends having the conversation from the age of thirty and to be investing in skincare and treatment options from your mid thirties.
Aside from adding lost volume, Dr Hkeik states that there are things we can do right now to preserve our skin’s existing volume and structure. Key areas to address according to Dr Hkeik are diet and exercise, including cutting back on sugar which breaks down collagen, and avoiding crash dieting.
‘Sugar…causes high levels of inflammation as well as glycation in our skin. As a result, we lose elasticity and collagen, so I would recommend a little bit less sugar in our diet.’
Dr Hkeik says that despite often being promoted as healthy, crash dieting where sudden and dramatic weight loss occurs, can do more harm than good for facial volume.
‘Crash dieting is a no-no in my practice, because you lose your facial fat pad and its very hard to regain those.’
Regular exercise encourages healthier skin, promoting more collagen and volume; the two things we need to fight the appearance of aging.
Essentially, the most important factor in creating and maintaining the appearance of youth is volume. According to Dr. Hkeik, instead of being concerned about wrinkles, what we really need to be looking at is how much volume loss our faces have experienced
‘It’s all about volume in the face and it’s all about contouring of the face. The more volume you have in the right places on your face, the younger you will look.’