Dr Val Lambros is one the plastic surgeons that I most admire because of his honesty and hard work. He has been looking at the facial aging by comparing the young faces to the older faces and demonstrating the changes that result from the aging process and how to correct them. He has been collecting 3D images from the members of the ASAPS over the years to be able to compare them and come up with results that would represent the male and female patients through different ethnicity. He showed a fascinating video of 3D dynamic morphing image that showed a computer averaged image of 100 people. It showed the average face through its aging process by comparing the young faces to the older ones. He demonstrated that the most significant part of aging is the changes that happen around the mouth the lower aspect of the nose. As he covered the mouth area there was some changes in the jowls and the neck but the most significant visible changes happened around the mouth.

What happens is that the bases of the nostrils move up with minimal drooping of the tip of the nose. The upper lip gets longer between the nostrils and the vermilion border and both the upper and lower vermilions get thinner. By looking at X-ray images of the young person and over imposing them to the X-ray images of the same person, but older, he demonstrated that there is minimal change in the bony skeleton and most of the changes are thinning of the soft tissues. My conclusion is that as I had always thought the shortening of the elongated upper lip not only established the youthful appearance of the upper lip, but by pulling the nostril and alar bases down, it establishes the youthful relations of the mouth and the nose, two of the central elements of the face. It also shows the importance of establishing volume on the face and the lips. The lip lift is again so important because the addition of volume to the lips will elongate the lips, something that we want to avoid. After the lip has been lifted, filling the upper lips and the base of the nostrils will effectively reverse the signs of aging.