A Focus on Innovative Approaches to Facial Aging


Watch the changes in the illustration here a few times – they are taken from real life. These are the changes that we can all expect over the course of a lifetime.

Volume is lost and gained in places. Features lose their sharpness. The jaw becomes lax. The skin dulls and wrinkles. New shadows appear. A different face, but the same face is almost unrecognizable from its face in youth.

At W Cosmetic Surgery, these sculptural changes are all addressed, combining art, science, and the most recent scientifically proven technologies.

We’ve written extensively about the facial aging process from a surface anatomy perspective—what an artist sees in changes associated with time—and from a deeper perspective.

Rembrant age 23


Age 29


Age 34


Age 53


Age 63
Age 26


Age 33


Age 46


Age 55

The bones remodel as part of the skeletal growth process. it doesn’t stop with adolescence. The jaws get smaller, and the forehead enlarges. The orbit gets larger. The bony aperture that is the nose moves backwards.

Muscles try to hold soft tissues in place — it is presumed that they increase their tone to hold up the structures. For that reason, Botox can sometimes be used to lessen the increased tone and relax muscles and the skin overlying them.

Because of the changes in the bones, a lot else happens. The upper jawbone change tilts the cheek backwards and the cheeks lose their fullness. The orbital rim bone becomes exposed, and above it, the fat pads of the lower lids become more apparent.

The tissues that hold the face in place—the ligaments—appear to stretch and in those stretched locations shadows appear (see illustration).

It’s been shown that there are compartments of fat—a deep compartment and a superficial compartment. Between them we have a layer of muscle or connective tissue. Multiple things happen at once—the connective tissue thins, and bulges appear. The fat pads shrink, and it seems that the deep fat pads shrink at a slightly greater rate than the superficial ones, causing gravitational collapse—things sag.

So, in some place we gain volume. In other places we lose volume.

The brows can rise in response to the fact that excess skin, volume loss in the upper lids causes one to reflexly lift the brows—or they can descend because the effort is too great to lift them.

Finally, the skin—that envelope that is exposed to the elements—shows signs of wear and tear, developing keratoses and pigment spots along with wrinkles. In very sun exposed areas, these changes can become malignant.

All that is a lot to look forward to.

Fortunately, all you need to do is to lie down and you will notice that a lot of these changes (except for the skin ones) improve.

We’ve looked at what happens when you lie flat. We’ve noticed that the volumes of the face shift back into place, that the cheeks flow back into place, and jowls disappear, that the nasolabial fold lessens, and the brows resume a more youthful position. In three dimensions, you look more than a decade younger.


A 54 year old woman a) upright smiling, b) lying flat, and c) 15 years before.


And that is our inspiration for how to address these facial aging changes.

We treat skin changes with aggressive skin management (Peels, lasers, radiofrequency microneedling, skin care). Learn more about our Facial Peels.

We treat volume loss with volumization using fat and fillers. (Liposculpture). While many surgeons utilize fat transfer using the Coleman technique, we perform liposculpture using an ingenious technology that continues to be developed by Dr. Roger Hogue that is the subject of multiple patents that we are fortunate to employ. The Hogue Prism Particle System allows us to obtain parcels of fat that has been refined of inflammatory debris that we can use selectively in multiple locations for multiple purposes and has taken our liposculpture experience and skills to a new level. Learn more about Liposculpture.

We treat the gravitational changes associated with aging by suspending the volumes of the face into the position they are in lying flat. We’ve shown that this produces a natural and durable result. We developed a technique and a technology that makes this procedure easy and safe. Lifting the cheek with an incision above the brow affects the shape of the whole face. And provides a long lasting result. Learn more about WNatural Micromidfacelift™.

Discover your possibilities.
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610 W. Germantown Pike, Suite 161, Plymouth Meeting, PA 19462
(610) 828-8880
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Monday – Friday 9am – 5pm
Saturday - Sunday Closed

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