The 5 R’s of Facial Rejuvenation

The Impact of Aging on Facial Appearance

Understanding how the face ages is the key to restoring a more youthful appearance:

The 4Ds of aging – skin:

  1. Deterioration of the skin,
  2. Dynamic lines,
  3. Deflation (volume loss),
  4. and Drooping or sagging that results from it.

and outline Dr. Hyland’s unique 5-R approach to reversing the external signs of aging and restoring a refreshed, rejuvenated totally natural appearance: 5Rs of Rejuvenation:

  1. Relax Dynamic Lines;
  2. Revolumize
  3. Recontour mid & lower face;
  4. Refine Specific features; and
  5. Resurfacing laser for texture, abnormal pigment, deep lines, and scars…

The 4 D’s or Visible Signs of Aging

  1. Deterioration of the Skin leading to fine lines, poor texture, and sun damage
  2. Dynamic Lines caused by expressions such as frowning, squinting, raising the brows,
  3. Deflation of Fat Pads in the cheeks and temples, leading to loss of volume,
  4. Drooping or Sagging of the skin causing deep nasolabial folds and jowls

The Aging Face | Ento Key


1. Deterioration of the Skin

As we get older, a combination of hormonal decline, toxins, and the effects of UV radiation results in the following changes in the skin:

  • Reduced moisture retention
  • Dull, dry rough surface texture with enlarged pores
  • Loss of elasticity and collagen manifesting as thin crêpey skin,
  • Fine lines around the eyes, progressing to deep etched lines forehead, glabella, around the mouth
  • Freckling or blotchy brown pigmentation
  • Actinic keratoses (precancerous) lesions which may progress to skin cancer
  • Redness– from photoaging, hormonal effects (spider naevi), local irritants eg harsh exfoliants, or from underlying dermatologic conditions such as rosacea

Factors That Accelerate Aging :

  • Hormonal Decline
  • UV Exposure
  • Toxins eg Cigarette Smoke


Hormonal Imbalances

  1. Androgen excess – in teenagers, young adults presents as inflammatory acne and in perimenopausal women as pimples, papules, hirsutism (facial hair); Hormonal imbalances can manifest in skin conditions and can be common in the perimenopausal years. Read more
  2. Hypothyroidism – borderline- dull dry skin; with more profound deficiency, a puffy myxedematous appearance with thinning eyebrows;
  3. Estrogen deficiency– thinning skin with loss of collagen & elastin, fine lines, and tendency to creepiness – so-called normal aging

Toxins in Cigarette Smoke

Interferes with the production of collagen, leading to accelerated aging, loss of elasticity (saggy skin all over the body), and magnify the detrimental effect of UV radiation on skin cells: as seen in studies of identical twins where twin B is the smoker…see link below

Photo of identical twins, one smoker Twins, age spots on the smoker

More information on the Smoking cessation Program

Aside from prescribing appropriate topical or laser treatments to optimize skin health, Dr. Hyland offers bioidentical HRT/hormone balancing, and a comprehensive smoking cessation program at the clinic.


2. Dynamic Lines

When repetitive expressions occur in the setting of loss of skin elasticity the result is expressive lines eg crows’ feet, frown lines, horizontal forehead lines ( see visible signs of aging).


3,4. Deflation and Drooping

Or loss of volume and sagging of the skin are caused by age-related changes in the bone and deep fat compartments of the face, manifested by the presence of deep nasolabial folds, marionette lines, jowls, hollows or bags under the eyes, flattening of the upper lip and puckering around the mouth.


Progressive Loss of Fat and Bone Resorption Results in Volume Loss and Sagging

The fat pads of the midface are responsible for the full, rounded appearance that we associate with youth. Much like a padded hangar, when these fat pads shrink, the face looks flatter as the skin that was stretched over them falls into folds – the nasolabial folds on either side of the nose, marionette lines that arise from the corners of the mouth, and jowls – which are skin folds hanging down below the jawline







With increasing age, the bones of the midface shrink, adding to hollowness and baggy skin under the eyes, flattening of the upper lip; and the fat pads of the temple shrink which further compromises support to the skin of the periocular (eye) area:

Age-related changes in the upper face due to Bone resorption in the periorbital area


Bone resorption in the upper and lower jaw leads to age-related changes in lips and chin

Putting the 5 R’s of Rejuvenation into Action

1. Botox RELAXES the Dynamic Lines
Lazer Room Botox (results may vary)


2,3,4. Dermal fillers REVOLUMIZE the shrunken fat pads, RECONTOUR (shape & sculpt) the face and REFINE or enhance specific features such as chin and jawline, lips and nose.
Lazer Room Fillers (results may vary)


5. Resurfacing lasers such as Smartxide CO2 laser, Fraxel Dual Erbium/Thulium lasers REMODEL deep etched lines & wrinkles, poor skin texture, and improve the appearance of scarring and unsightly brown pigmentation
Lazer Room Resurfacing (results may vary)

Color Skin

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