Understanding the Face in a New Era

We may not be responsible for how we look when we are born, but our face at 50 bears the record of a lifetime of choices… – Abraham Lincoln

In this series of blogs about the face, I hope to review with you information available to us about the face, what we look at and what the face really means. The face is a window to the soul as they say…. It gives the first impression of the individual’s health /diseases, beauty /attractiveness, personality / emotions, and communication skills. What you see may be different than what draws your attention when looking at a face. How do you determine someone is beautiful, or attractive, or friendly, or kind? I will try to dissect the different points of view that in the end make up what you perceive when looking at your face in the mirror or when looking at someone else’s face.

The human face is the most prominent visual object in our social environment. The consistent appearance of the face allows for the attribution of identity to a person. The face, despite recent advances in assessing identity such as biometrics and DNA testing, remains one of the most important features in ordinary life for identifying an individual person. Some features of the face are permanent like the eyes, nose and teeth. Other features are transient, such as facial expression. Combinations of both of these provide a wide source of information to the observer that link us all together in society. Such permanent features of the face also convey information about the genetic background of the person, including ancestry and ethnicity. These features also allow for basic nonverbal communication among people, and are often the basis on which we form significant impressions of such characteristics as friendliness, trustworthiness, and status. The more accurate our perceptions, the greater advantage we can have socially.

The relatively permanent and semi-permanent appearance of the face is formed by several components:
1. The shapes and placement of the bones of the skull,
a. Forehead
b. Cheeks
c. Jaws and Chin
d. Profile

2. The shapes and placement of cartilage of the nose and ears,
3. The shape and color and placement of eyebrows, eyelashes, eyes
4. The mouth in all its possibilitites


5. The skin, of the face and neck, color, texture and hydration
6. The soft tissues: subcutaneous fat, dimples and clefts
7. The facial muscles which relate to facial expression.
8. The facial hair, lines, wrinkles, gestures, and body talk

We live in an intricate, ever-changing web of human relationships. When you look into someone else’s face, or even your own in the mirror, what you see is a composite of signs from many sources. The bony structure, shapes and positions of features such as the eyes, mouth and nose, and color and texture of the skin all have an influence in your opinion. Facial expressions are created by muscular actions, some of which are voluntary and some are involuntary or subconscious. Facial expressions have their roots in the earliest ancestors of the human species, but these expressions continually evolve and change via both biological and cultural mechanisms. The facial muscles produce the varying facial expressions that convey information about emotion, mood, and ideas. Emotion expressions are one primary result of activity by the facial muscles.

The feelings and emotions expressed by the face can be infinite and can also be combined to specifically determine what you are feeling without using a single word. We can all recall that raised eyebrow from our mothers indicating their disapproval….

Some examples of feelings and emotions that the face can express include:
1. Happiness
2. Sadness
3. Anger
4. Surprise
5. Fear
6. Excitement
7. Worry and concern
8. Deep thought and concentration
9. Sexual and romantic interest

The art of studying the face and its relationship to the individual that carries it is often referred to as physiognomy, or ‘face reading’.

Physiognomy is defined as:


1. Facial features: the features of somebody's face, especially when they are used as indicators of that person's character or temperament


2. Judgment of character from facial features: the use of facial features to judge somebody's character or temperament


3. Character or appearance of something: the character or outward appearance of something, e.g. the physical features of a landscape




Proposing an association between these facial features and other aspects of the person, including personality, character, temperament, romantic compatibility, or even the destiny of the person, is a physiognomic approach. Such associations might include a person's genetic background (e.g., race, ethnicity, and family membership) and genetic diseases (e.g., Down Syndrome). This approach also takes into consideration that experiences and emotions will slowly change a person’s facial features over time. These slowly changing features are also modified by the aging process (expressive lines and wrinkles).



The study of human facial expressions has many aspects, from computer simulation and analysis to understanding its role in art, nonverbal communication, and the emotional process. Facial expressions and the ability to understand them are important for successful interpersonal relations, so improving these skills is often recommended as they are an important channel of nonverbal communication. Even though the human species has acquired powerful capabilities in the verbal language, the role of facial expressions in person-to-person interactions remains substantial. Messages of the face that provide commentary and illustration about verbal communications are significant in themselves. In understanding the face, the private, hidden side of the inner person may be seen, a side which may not be accessible in the form of verbalizations. For example, the facial behaviors related to emotion can reveal a feeling side of a person's private life. Such emotion indicators range from full-face expressions that are obvious and stereotyped, to fleeting, partial-face movements that are hard to see.



Emotion is a topic frequently raised in discussions of the face. This is because it is well known that the face assumes appearances characteristic of each of the passions that people experience. Therefore, it is no wonder that artists have tried to capture facial expressions in drawings; philosophers have speculated on their functions and forms, and biologists have speculated on their origins. There is substantial evidence captured in the late 20th century by psychologists, anthropologists, animal biologists, and other scientists that emotion resides in facial expression. Today, the topic of emotion and its relation to facial expression has re-emerged into prominence in psychological studies. Despite controversy, the realities of emotions, and any characteristic appearance of the face that might correspond to them, have become paramount in understanding people, how they relate to themselves and others.



Understanding these connections is also very important when looking at a face from the point of view of the multiple arrays of procedures and products available today for facial rejuvenation. People know that aging is inevitable, yet our society’s fascination with aging has made these procedures quite popular. So instead of fighting it, I invite you to look at a new way to view the face, in the context of graceful aging as well as understanding what exactly is happening in the world of faces.



When studying the human face, its appearance, and how the face moves and behaves, each independent feature requires special attention. Attractiveness, emotional and physical health and aging are features that can be readily determined and easily captured when looking at a face. They too can be deceiving.

The Features of a Healthy Face

The expression of a given face at a specific time is conveyed by a composite of signals from several sources of facial appearance. As we discussed earlier, some of these sources are relatively fixed; others, more changeable.

The facial features that closely relate to the health of an individual include:

1. The general shape of the face (oval, almond, square),

2. Orientation and pose

3. Position of the facial features (hair, teeth, eyes, nose and mouth)

4. Coloration and condition of the skin

5. Blood flow (pale vs. flushed)

6. Glandular secretions (tears, saliva)

7. Shapes, depth and number of dimples, wrinkles, folds, and lines

8. Facial Expression and muscular activities


Facial attractiveness is about what people define as beautiful. This is a very subjective matter, not only is it determined by the facial features themselves, but also determined by the persons attitude, hygiene and overall health. The whole person plays a significant role when being judged for attractiveness.

The face and its appearance can reflect certain disease processes and overall health. An example of this is the characteristic face of a person with excess steroids or cortisol. It is usually round and described as a ‘moon face’. Another example is the characteristic face of a person with Down Syndrome. Aging, on the other hand, is about the effects of time over the life span, while preserving the facial identity of an individual. Facial aging is evidenced by expressive wrinkles, sun damage and abnormal pigmentation, and overall skin texture and hydration. Subcutaneous fat is also important in facial aging.

The Face over Time

If a stranger wants to know another person's age, he or she can either ask for identification or look at the person's face. People are able to determine age from the face with surprising accuracy. This skill is developed early in life, when babies can distinguish children from adults, and can be very useful in life for good communication and interpersonal skills.

As the face matures, the greatest changes occur from infancy to puberty as the face and head mature into an adult form. The eyes, nose, and mouth features of the face expand to fill a relatively greater area of the surface of the cranium; the relative area occupied by the forehead shrinks as the eyes move up into this area; the eyes become proportionately smaller and the forehead slopes back more; the face becomes smaller in respect to the rest of the body; and the chin tends to become larger and more protrusive. After puberty, some of these changes may continue, but less dramatically, into adulthood. Hormones have a significant impact on the way a face changes, allowing for gender differences and signs of hormonal imbalance.

Some features of aging include changes in the color of the skin. The skin tends to become darker and the pores become more obvious. Skin texture becomes less flexible and less elastic, and increases in roughness. The birth of prominent lines, wrinkles, folds, pouches, and blemishes or discolorations marks a turning point in aging. The subcutaneous fat may decrease with changes in weight, and or migrate with increase in weight, leading to pouches in the cheeks, bags under the eyes, sagging under the chin or a double chin. Changes occur in the vascular supply of the skin. The hair also changes, the degree of shine determined by the oil and sweat glands, the number and thickness of hair also are changed with time. These changes appear gradually and become more pronounced over time. With time, there are also changes in the movements and behaviors of the face, where fine control of the facial muscles is lost, similar to finger dexterity. An aging face shows changes around the eye, with expansion of the eye area (droop), changes around the ears, nose and mouth where the features appear larger and fill a greater area of the head; less forehead area, and more chin.

Despite the often dramatic changes in the face as it ages, the identity of the face is preserved throughout the person's life. The elements of facial identity of each person can be detected from early childhood through old age, though it may be difficult to match a face using only the extremes of age, versus seeing the steps as the face develops and ages.

What to Do About Aging and Wrinkles

Wrinkles can be seen as problematic. Today’s beauty concept is all about revealing a youthful healthy appearance. The best way to deal with wrinkles is to prevent or postpone them for as long as possible. One of the most important wrinkle preventatives is to avoid sunlight. The sun's rays penetrate the skin surface and physically destroy tissues of the skin, leading to sun damage and wrinkles. If you seek a tan in the sun, you will without doubt pay for it later with premature wrinkles. Tanning is caused by the sun stimulating production of melanin as a protective response against sunburn. Generous and frequent use of sun screen products generally can reduce the degree of sun damage, but cannot totally prevent it. Although darker skin types are less vulnerable to sunburn (though not immune), their response to the wrinkling action of the sun is not significantly different.

Another way to prevent premature aging and wrinkles as well as to properly care for your skin is to exercise regularly and consume a healthy diet, rich in fruits and vegetables, fiber, low in saturated fats, processed foods, sweets and carbohydrates. Supplements are also worth considering when maintaining a healthy youthful bright skin. Vitamins that claim to have beneficial effects on the skin include Vitamin A, C, D, and E.

Once you have unwanted wrinkles, it is important to notice what these wrinkles are saying about you. Some are due to frequent expressions and emotions. Some are very important in defining who you are, your personality and your character. For the wrinkles you don’t like, there are some techniques for reducing them even making them disappear.

Cosmeceuticals are special creams and lotions usually prescribed under the supervision of a physician. They contain prescription grade substances that have been blended with cosmetics. If used correctly are effective in reducing lines, wrinkles and unsightly pigments. These substances act by increasing the cell turnover and volume of tissue cells, hydrating the cells, and smoothing out wrinkles and lines through exfoliation. They are particularly useful when started early and if used routinely on fine lines and wrinkles, but they cannot eliminate deep wrinkles. In our future blogs I will discuss these in more detail.

Laser and light systems are FDA approved for a variety of conditions, including sun damage, freckles, hormonal pigments (melasma), uneven skin tone, large pores, pigment lesion removal, fine lines, wrinkles, broken capillaries, fine facial veins, spider veins, port wine stains and other birthmarks, brown spots and rosacea. There are different kinds such as CO2, YAG, LED, and IPL.

Injectables: Recently, Botox and other injections have become popular as a treatment for wrinkles. Botox is one of the most commonly used. Botox acts by blocking neurotransmitters to the muscle, thus blocking muscular contraction. The blocking action has important medical uses, and also has the effect of reducing wrinkles that are the product of chronically tense or frequently contracted muscles. When Botox is applied the muscles contract less (partially paralyzed), and the wrinkles are minimized. Thus, only wrinkles that are produced or enhanced by muscular actions are ideal for Botox treatments. Other wrinkles, lines and folds that are not primarily a product of muscle contractions will not be affected. The primary site for using Botox is around the eyes where the wrinkles are due to constant frowning; so partial loss of muscular action in this area will not cause functional problems and actually have the benefit of reducing the eyebrow frown. Effects of Botox are transitory, and last just a few months, so subsequent treatments are required to restore its effects. Other injectables are classified as ‘fillers’. These substances ‘fill’ the wrinkle making it less obvious. I will also dedicate a full blog to injectables and review what is out there in the world today.

Another way to tackle aging in the face is through surgery. The face lift is a proven effective cosmetic surgery treatment for wrinkles, pouches, bags, and sagging skin. You should have severe wrinkling to warrant this expensive and drastic step. The surgeon literally pulls the skin tighter on the bones of the face. Because the skin continues to age, the signs of age will eventually return and another face lift will be needed. However, the elasticity of the skin decreases with age and its ability to respond well to the lift also decreases, so signs of multiple lifts eventually negatively affect aesthetic judgments of the face. Careful selection of physician is an obvious consideration for such a procedure.

As I stated earlier, we will dedicate a separate blog to explaining all the different facial treatments available today. More specifically, I want to provide a useful review of what a woman can do to reduce the signs of aging while continuing to look natural and healthy in keeping with her identity.

I want to encourage every woman to care for her body and her appearance in a healthy way. We will start by understanding what is out there, debunk the myths and taboos over special treatments, and allow for better judgment when caring for the mind and body. I want to encourage young girls to care for their skin yet know that beauty is not just skin deep. Also, I want to introduce a revolutionary way to perform Botox and other facial injectables and at the same time preserve the expressions that define a person, with clear knowledge of how other people ‘read’ our faces. In short, I plan to use physiognomy when talking about injectables, and offer a different approach to help my patients maintain a more natural younger appearing face that continues to express their personality and emotions and at the same time appear youthful, relaxed and healthy.

Thank you for reading,

Margarita Ochoa-Maya,MD
www.AdvancedHealthNH.com
www.FreedomToHeal.org

Of the many kinds of human intelligence, emotional intelligence and social awareness it brings, is the primary determinant of personal success – Daniel Goleman, PhD