Physical Examination of the Aging Face
Much of the surgeon’s appraisal of the aging face can be performed through close observation during the introduction and history phase of the initial meeting. The surgeon should observe the patient’s hairstyle, including the presence or absence of bangs, hair thickness, and the height of the hairline; the use of the frontalis; the position of the brow; the texture and quality of the facial skin; and the presence and location of rhytids, telangiectasias, pigmentary dyschromia, and expressive furrows.
If chemical peeling or laser skin resurfacing is being considered, the surgeon should also note the patient’s Fitzpatrick skin type, which affects the skin’s response to these procedures. The Fitzpatrick scale classifies skin into 6 types according to skin color (before sun exposure) and the reaction of the skin to sun exposure. The higher the number is, the greater the amount of skin pigment. Thus, Fitzpatrick type I refers to fair skin with minimal pigmentation, and type VI represents skin with marked pigmentation.
In addition, the surgeon should assess eyelid skin and fat along with eyelid margin position relative to the pupil and cornea, presence or absence of horizontal lower eyelid laxity, midface position, presence of jowling, accumulation of subcutaneous fat in the neck, and chin position, noting any nasal deformities, tip descent, or broadening, as well as thinning of the lips. The surgeon may find a side view of the neck to be particularly helpful in determining the extent of aging. Preoperative photographs should be available in the operating room.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.