Skin aging is a multivariate phenomenon that is influenced by an interdependent and patient-specific footprint of biologic and chronologic aging processes. The most common patterns of aging include degenerative changes to the skin, muscle, muscle fascia, and adipocyte. The interplay of these four variables is a fundamental focus of a modern plastic surgery practice. Plastic surgeons must be proficient in skin aging pathophysiology and the mechanisms to optimize skin with topical dermatologic monotherapy alone, or as a prelude to surgery or laser. The focus of this chapter is to highlight the importance of skin aging in the global assessment of the cosmetic patient and to elucidate the role of skin optimization in the management of the patient requesting rejuvenative cosmetic surgery.
