[@PeterAttiaMD] What Really Causes Under-Eye Bags and Sagging Skin | Tanuj Nakra, M.D. & Suzan Obagi, M.D.

Link: https://youtu.be/kQTO9RcWr2M

Short Summary

Here's the breakdown based on the transcript:

• Number One Action Item/Takeaway: Women should consider hormone replacement therapy (HRT) early in their 40s to potentially mitigate bone loss and fat atrophy in the face that accelerates after menopause, contributing to premature aging.

• Executive Summary: The aging face, particularly in women, is significantly affected by bone loss and fat atrophy. This process is often hormonally driven and accelerates around menopause, leading to a loss of facial volume and definition. Early consideration of hormone replacement therapy may help slow these changes.

Key Quotes

Here are five direct quotes extracted from the provided transcript that represent valuable insights or interesting data points:

1. "So, we look at the vault, the bony vault of a 20-year-old and the opening around the eyes are nice and tight. The cheekbones are nice and wide. The jawline has a really good definition. And then you look at someone who's in their 60s and all of a sudden the opening around the eyes are wider...the cheekbones are less wide, jawbone is less wide, less height. And so now you've got that scaffolding that's diminished and all the skin looks like it's just hanging and that's what's happening."
2. "From 50 to 60 or 70, women will age about 20 years faster than men. In the lower face, especially, they will get so much atrophy in the mandible that they'll start to get that. That's why women start to say, "I hate my neck and I hate the loose skin in my neck.""
3. "The facial fat pads are very unique metabolically... Yeah, there are a couple compartments that might in time get thicker, such as the nasol labial fat compartment, which is why some people have that deep fold... But for the most part, they atrophy. And so if you go through this yo-yo change with your weight and you're progressively getting thinner and then gaining some weight back, it doesn't go to the face. It goes to parts of the body we don't want. But the face continues to undergo that weight loss or the volume atrophy."
4. "And so, um, so we know that fat is not the same throughout the body and it's not the same in the face. Um, there is a general, uh, consensus that beta carotene is an anti-inflammatory mediator. um and higher concentrations and lower concentrations of betaarotene can have some effect on the metabolic health and of of fat especially how it responds to stress."
5. "So when we do fat grafting for example and we take fat from the abdomen which has the highest concentration of stem cells priiposytes there and put them in the face the fat starts to behave more like the fat from the abdomen when you put it in the face and if they gain weight...it retains its source."

Detailed Summary

Here's a detailed summary of the YouTube video transcript, focusing on the core discussion and excluding promotional material:

• Aging Face Biology: Overview

  • The conversation centers on the biological changes that occur in the face as it ages.
  • Focus is limited to the neck upwards.
  • Key question: Why does a face look younger 10 years prior?

• Fat Compartment Atrophy

  • Youthful faces have plump, robust fat compartments (approximately 11 on each side).
  • These fat compartments provide volume and padding between skin, muscle, and bone.
  • With aging (late 60s), significant atrophy occurs in most facial fat pads.

• Bone Structure Changes

  • Bony vault changes with age (demonstrated with diagrams of 20-year-olds vs. 60-year-olds).
  • In younger faces, eye openings are tighter, cheekbones are wider, and jawlines are well-defined.
  • In older faces, eye openings widen, cheekbones lose width, and jawlines lose definition and height.
  • Bone loss leads to diminished scaffolding, causing skin to sag.
  • Early changes typically begin around the eyes.

• Hormonal Influence on Bone Loss

  • Bone loss in the face, particularly around the eyes, is hormone-related.
  • This is especially noticeable in women.
  • Hormone replacement therapy is suggested as a way to maintain bone health and potentially mitigate these changes.
  • Women in their 40s may begin to see these aging changes.

• Gender Differences in Facial Aging

  • Men often maintain their facial bone structure, fat volume, muscle, and skin thickness longer than women.
  • Between ages 50 and 60 or 70, women can appear to age 20 years faster than men, especially in the lower face.
  • Women experience greater mandibular atrophy, leading to loose neck skin.

• Osteocaneous Ligamentous Network of the Face

  • Bone structure is the foundation for facial aesthetics and youthful fullness.
  • CT scans over time (studies from the 90s and 2000s) show receding bone structure (mandible, maxilla, frontal bone).
  • Ligaments attach skin to bone (osteocaneous ligamentous network). These are universal.
  • Fat loss and bone recession cause ligaments to tug on the skin, creating deep lines.

• Facial Fat vs. Body Fat

  • Paradox: People accumulate body fat with age, but lose facial fat.
  • Facial fat pads are metabolically unique.
  • Weight gain and loss cycles (e.g., pregnancies) can thin the face over time.
  • Weight regained after weight loss doesn't typically return to the face.
  • Facial fat pads tend to atrophy, while the nasolabial fat compartment can thicken.

• Biochemical Mechanisms of Facial Fat Loss (Unknowns)

  • The exact biochemical mechanisms behind facial fat loss are not fully understood.
  • Fat cells in the face may become defective and unable to re-accumulate fat.

• Differences in Fat Composition

  • Facial fat is different from abdominal or lower extremity fat.
  • Fat pads in the eyelid region have different colors, indicating compositional differences (e.g., beta-carotene levels).
  • The source of fat used in fat grafting can affect its long-term behavior in the face.

• Stress and Facial Aging

  • Facial fat and skin are sensitive to stress, particularly cumulative stress over time.
  • High stress levels (common in 30s and 40s due to career, family, finances) contribute to facial volume loss and skin aging.
  • Lifestyle factors, cortisol levels, and inflammation play a role in facial aging.
  • Chronic cortisol elevation may be anabolic to fat below the neck, but catabolic to fat above the neck (accentuating facial fat loss).
  • Beta carotene, and anti-inflammatory mediator, can have an effect on fat metabolism and stress response.

• Lifestyle Influence

  • Stressful lifestyles accelerate facial aging (illustrated by examples of different women).
  • Quality of science in aesthetics has historically been poor and impacted by industry profits.

• Muscle Glide and Fat Compartments

  • Fat compartments allow muscles to glide smoothly during facial movements.
  • It's unclear why fat compartments undergo such atrophy given this important function.

• Fat Grafting Behavior

  • Fat grafted from the abdomen to the face retains characteristics of abdominal fat.
  • If the patient gains weight, the grafted fat can hypertrophy.