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Corner Clinic


By UC San Diego Health Experts   |   May 11, 2018

Our experts answer your questions on everything from headaches to tummy aches. This month, our experts discuss experts discuss how facial bones change with age, eye floaters and if childbirth causes pelvic floor disorders.

  1. How do facial bones change as you age?
  2. Occasionally I get eye floaters, these black bits that seem to drift across my eye. They don't hurt but they're distracting. What are they and how do I get rid of them?
  3. Can childbirth cause pelvic floor disorders?

How do facial bones change as you age?
Amanda Gosman, MD, plastic surgeon at UC San Diego Health

The bones of the face lose volume as we age. In scientific studies that compare the bones of the same people over time, it is noted that there is bone loss in the orbital bones around the eyes. This change can make the eyes look more sunken and the lateral brow area to look droopy as we age.

The bones of the midface and upper jaw resorb over time, which can contribute to some of the descent of the soft tissues of the cheek and the formation of jowls. As the soft tissues of the cheek lose volume and descend because of the loss of bony support, the appearance of bags under the eyes may be accentuated. The bone of the maxilla around the sides of the nose also loses volume, which can contribute to deepening of the nasolabial folds (smile lines) and drooping of the nasal tip.

The length and height of the lower jaw diminish as we age. The loss of volume of the bones of the upper and lower jaw can make the lips appear thinner and longer. Plastic surgeons can offer effective techniques for facial rejuvenation by correcting the effects of aging on both the soft tissue and bones of the face.

 Daniel Chao

Occasionally I get eye floaters, these black bits that seem to drift across my eye. They don't hurt but they're distracting. What are they and how do I get rid of them?
Daniel Chao, MD, PhD, ophthalmologist at UC San Diego Health

"Floaters" are fragments of the vitreous — a gelatinous substance present in your eye. As you age, the vitreous gradually liquefies, and at some point, usually in middle age, the vitreous detaches from your retina. This can result in the sudden appearance of floaters or flashes of light. Normally, they do not cause any problems, but sometimes this vitreous detachment can lead to tears in your retina, which can lead to retinal detachment. Therefore, it's wise to get an eye examination from an ophthalmologist immediately when one has a sudden onset of significant floaters or flashes to determine whether you have a retinal tear or detachment. 

This vitreous detachment is not harmful in and of itself. While distracting at first, these floaters will usually settle out of your visual field in a few months, and people adapt to the presence of these floaters. If the presence of floaters is debilitating and is significantly affecting your quality of life, treatment options include surgery to remove the floaters or an office laser procedure to fragment the vitreous. However, these procedures carry risks, including irreversible vision loss, and most retinal specialists are hesitant to consider intervention unless these floaters are truly disabling to your life.


Can childbirth cause pelvic floor disorders?
Marianna Alperin, MD, urogynecologist at UC San Diego Health

Yes, childbirth can certainly lead to pelvic floor disorders (PFDs), which include pelvic organ prolapse, urinary incontinence and fecal or anal incontinence. In fact, epidemiologic studies consistently identify vaginal delivery as the key risk factor for these morbid conditions that negatively impact lives of millions of women world-wide. Based on a recent cross-sectional study of community dwelling women in the United States, the prevalence of at least one PFD was 23.7 percent. The probability that a woman will undergo surgery for PFDs in a lifetime is 1 in 5. Furthermore, PFDs often coexist, with a third of women having two or more disorders.

Vaginal delivery increases the odds of developing substantial prolapse later in life by 6to 10 times, compared to Cesarean section. Urinary incontinence is also associated with vaginal childbirth, especially stress urinary incontinence, which is defined as involuntary loss of urine with any maneuvers that increase intra-abdominal pressure, such as coughing, laughing or jumping.

The odds of stress urinary incontinence are approximately three times higher in women who give birth vaginally, compared to women who do not. With respect to anal incontinence, obstetrical anal sphincter injury is one of the leading risk factors for fecal incontinence in women. Despite a decline in the use of routine episiotomies, obstetrical anal sphincter injury continues to complicate close to half of all vaginal deliveries, with 11 percent diagnosed at the time of delivery and an additional 35 percent diagnosed postpartum. However, in the absence of obstetrical anal sphincter injury, the association between vaginal childbirth and anal incontinence is less clear.

Given the strong existing evidence of an association between vaginal childbirth and PFDs, it is important to counsel women regarding these risks, which need to be balanced against the risks associated with abdominal deliveries, while taking into consideration the specific demographic and clinical characteristics of each individual patient.

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