The Anatomy Lesson I Was NOT Prepared For

Did You Know Your Face Changes Right Down to the Bone as You Age?

One of the things I absolutely love about aesthetic medicine is understanding what’s actually happening beneath the skin as we get older. It’s anatomy! And I love anatomy and physiology! I got the highest scores in my A levels and university exams, I could explain to you the propagation of an action potential but I equally walk into the supermarket, kids hanging off me and forget what I went in for, panic buy and come out with nothing useful. We all have our strengths and weaknesses.

Anyway, the point is, facial ageing isn’t just about wrinkles or losing collagen.

Our entire facial structure changes. Even our bones!

Our facial skeleton continues to remodel throughout adulthood, and changes in areas such as the eye sockets, cheeks and jaw can affect the support of the tissues above them.

Then there’s our facial fat, which isn’t just one continuous layer. It’s arranged into different compartments that can lose volume or change in distribution as we age.

This is why somebody might notice hollowing around their temples or cheeks but also feel like their lower face is becoming heavier.

Add changes in skin quality, collagen, elasticity and hormones into the mix, particularly oestrogen! Menopause time is not kind to us! and so, you start to realise just how complex facial ageing actually is.

And this is exactly why I find anatomy so fascinating.

The anatomy lesson I was NOT prepared for 😂

One of the most memorable experiences of my aesthetics career was attending specialist cadaveric dissection at the Royal College of Surgeons of Edinburgh! Which by the way was just so emotional for me because I had read about Robert Knox as a child, I’d read about medical advances in the surgical field, I’d visited the royal college of surgeons as a tourist, I’ve always been fascinated by medicine, so to walk in there, as a delegate, having dinner with medical experts in the surgeons library - I had the worst imposter syndrome! I cried my eyes out, little me from Rossendale, in the Royal College of Surgeons, I couldn’t actually believe it!

Now, before I go any further, I need to admit something.

I didn’t actually know what a cadaver was.

Yes. Really. 😂

I’d booked myself onto advanced anatomy training because I wanted to understand facial anatomy in more detail, without fully appreciating what I’d signed myself up for. I thought play-do.. no joke ..

To say I was unprepared would be an understatement.

I found the experience genuinely traumatic.

There’s a huge difference between studying anatomy in textbooks and being confronted with actual human remains. Eight of them, presented on tables in a laboratory, all surgical fields neatly laid out, us all donned with surgical gowns, gloves, visors, masks, pinnies, even covering our shoes. As if I was an actual surgeon.. that was exciting but also these were real people who had lived real lives, and I found that incredibly difficult. I’d lost my dad in December in the most traumatic way so I think this is why it triggered me so much. It was the first time attending a BAMAN event but it was the one that changed my career.. in the best way. The overwhelming amount of support I have had from practitioners in medical aesthetics, nurses, wanting to support me, help me in anyway they could was emotional, I was speechless for days after that weekend. Aesthetics can be lonely and scary as a sole practitioner, but I left with a sense of belonging to a community, like I do in the ICU with my MDT team. Professionals that share the same passion for safety and standards as I do.

Although I was faced with this room that felt so huge, full of established medical professionals, the weight of those remains around me, I almost couldn’t do it. But the way that each cadaver was treated with the upmost respect by everyone in that room, it was so emotional for me but seeing how professionals worked and how respectful we all were was so humbling. I’m so grateful to those that gave us this opportunity, and to BAMAN, I don’t know how they provide opportunities like this to us but it’s an opportunity you definitely don’t get in any other institution. If you’re a practitioner and a nurse, you need their support. I feel like my nursing practice in aesthetics now is so intentional. I know what I’m doing, I know what I offer, what kind of practitioner I want to be and I understand the risks fully to be a safe practitioner. I’m so glad I did it now, but I wouldn’t have got through that weekend without those BAMAN members. Feeling emotional even writing about it now. Lol.

The experience also gave me a completely different appreciation of just how complex the human face is.

Seeing the anatomical layers, blood vessels, nerves, muscles and fat compartments reinforced how much responsibility comes with injecting into these tissues.

And although I found it emotionally difficult, i have enormous respect for the people who donate their bodies to medical education.

So what does this mean for aesthetic treatments?

It means I don’t want to look at somebody’s face, see a wrinkle or hollow and automatically think about putting filler into it.

I want to understand why it’s there in the first place.

Is it related to changes in bone structure? Facial fat? Skin laxity? Or a combination of things?

Because adding volume isn’t always the answer.

And as I’ve discussed in my previous article about dermal fillers, I’m becoming increasingly interested in the long-term consequences of our treatments.

I don’t think continually adding more product without considering what’s already there is a sustainable approach to aesthetic medicine.

I want treatments to have a purpose, supported by an understanding of anatomy and the best available evidence.

And sometimes that means deciding not to treat at all.

The more I learn about facial anatomy, the more questions I have. And I think that’s a good thing.

We should never stop questioning what we’re doing, particularly when we’re working with people’s faces.

I don’t want to stop you ageing. I want to help you understand how you’re ageing and support you in ageing well.

Ashleigh x 🤍