Dr. Little’s Philosophies
The Complexity of Facial Aging
As any portrait artist understands full well, the human face is a complicated structure…even at rest (let alone when animated).
Facial Aging Is Complicated
It should not be surprising, therefore, that human facial aging is itself a complex process that brings a multitude of outward changes that combine to create the aged appearance, with its evident lack of vitality, health, engagement, and beauty. Some of these changes are more important than others, of course, but almost none of them are unimportant. By the way, the typical plastic surgery patient is as skilled at recognizing an aged appearance as the plastic surgical expert or the professor of anatomy (and may be even more skilled at recognizing any element of unnaturalness that may follow its treatment). That is because the gestalt or overall impression of aging is taken in instantly and subconsciously by the viewer, not as a conscious calculation of its multiple contributing factors.
Many patients (and cosmetic surgeons) may consciously perceive only a few of these component changes of aging…at least until they are taught how to see more of them (remember: “the eye cannot see what the mind does not know”). And if one can’t “see” something, one can’t correct it (or ask that it be corrected). A mistaken focus on some of the more obvious changes during facial aging has led to intuitive surgical practices in the past that have not proven as effective in alleviating apparent aging as hoped. To mention but two: the relief of facial lines and creases by pulling the facial surface tight has brought more a look of unnaturalness than one of youth (the youthful face, by the way, is not tight), and the removal of fatty bags around the eyes has often emphasized a look of skeletal emptiness rather than health.
Specialized Photography Helps to See More
In the photographic Results section, therefore, yellow lines and ovals have been added to help the viewer better appreciate some of these component aspects of aging (and how each responded to treatment). Even so, only a small number of such total changes can be pinpointed in still photographs. More become evident when before-and-after photographs are superimposed and faded between one another. And still more become apparent in dynamic (video) views. But the best way to appreciate the full benefits of architectural rejuvenation of the face is to meet the active, real-life patient herself.
Illustration: detail from Leonardo da Vinci, “Study of the Proportions of the Head and Face,” ca. 1489-1490, Royal Library, Windsor