Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Facial Aging

Facial aging starts early. Even while the face is maturing to one’s twenties, the skin is aging. Volume changes in the face and eyelid aging appear in the thirties and drooping starts to become evident in one’s forties. Wrinkles and skin changes become apparent over time.

facial aging3

Older faces may come to look miserable, tired, sad or unhappy and can convey a range of negative emotions to the world that simply do not reflect the way you actually feel or are. The emotional message conveyed is wrong or out of kilter.

And people age at different rates. Some look older than their years and have an advanced facial age while the lucky ones appear youthful. Genetics plays a role in this, but also sun exposure, smoking, diet, exercise and stress.

There are three major changes of facial aging and a better understanding of these changes has led to a refinement in facial rejuvenation. Most obviously tissue descends. The cheek mass comes down leading to jowls and a sloppy jaw line. The naso-labial folds and marionette lines become deeper and the mouth can become unhappily downturned. The tail of the brow may descend, but the brow itself may become peaked or drop. Cheek descent also results in it falling away from the eye deepening the tear troughs and the grooves under the eye. And the neck descends.

Volume changes in the face may vary from patient to patient but typically, and this occurs when still surprisingly young, there is volume loss from the upper face. The temples can become hollow and the grooves under the eye more pronounced. Volume loss occurs over the cheeks and around the mouth as the lips thin and the naso-labial folds and marionette lines deepen. This deflation affects all tissue layers of the face: the skin thins, the fat and the muscle atrophy and the bone resorbs. It is evident in old people whose bones and veins become visible.


The skin deteriorates with aging: wrinkles and pigmentation appear and the skin loses its elasticity – its ability to recoil back to its pre-stretched state. Skin detioration is made worse by sun exposure, cigarette smoking and an unhealthy diet.


With aging the V or heart shaped face of youth becomes squarer, more masculine looking and less happy, a kind of disproportion typical of an old appearance. The changes, descent of tissue, deflation and volume changes and deterioration of tissue are different in each face which is why treatments need to be individualised. Some patients require more lifting, others more volume correction. The goal of facial rejuvenation is not only to reverse these changes, but to do so safely, simply and with minimal downtime and complications. Further, it is also to find the inner beauty which exists within each face.

Facial Aging


We have met before – about 10 years ago – I was kicked in the face by my horse and you performed the surgery (rather brilliantly). Now I am interested in something else…

All 6

I just want to thank you again:) I’m super happy. Could you please send the before and after u fixed it pics, I would like to show my mum.

All 7

From a cleft patient who had secondary surgery to help her speech:
It is one year ago that i was blessed to meet and know you. Thank you very much for the support you rendered to me while I was in South Africa. I will never forget your acts of kindness. I am fine now and my speech has greatly improved! I think I don’t need another operation. Even though I don’t communicate that often, you are always at heart.


I would just like to take the opportunity to say THANK YOU to Dr. Lazarus and his team.
I have had a very good experience due to the pleasant staff and of course Dr. Lazarus himself.

All 9

I am feeling uncomfortable and not very proud of myself! I did not get round to expressing my gratitude and appreciation to you.! Dirk, thank you so very much for all your kindness and understanding throughout my dealings with you and it has been always been a pleasure dealing with your entire practise.

All 8

Actually drove past your surgery this morning and thought I should pop in to say hello. Am very happy with the way the surgery has turned out, has made a huge difference and am very grateful. I will endeavour to pop in sometime in the near future to let you have a look.

All 6

Dear Anneli

I came to Capetown from UK about 9 years ago and sought out Dr Dirk for cosmetic surgery. He performed a tummy tuck, lipo, and facelift on me during my time there and I don’t think I have ever written to thank him for the wonderful work he did. Thank You to him and all you ladies on his staff. I attach 2 shots of me on the beach in France, showing my nice flat tummy.

All 5

Hello again, Dr. Lazarus!
Once again I would like to say how pleased I am with the result of your handiwork!

All 4

You are such a STAR thank you for all your assistance.

All 3

Just a quick thank you to all the staff – felt in safe professional and caring hands from the moment I walked through the door this morning.

All 2