Examining the face involves a systematic inspection focusing on skin condition, underlying structures, and any abnormalities. This includes looking for signs of aging, skin lesions, and structural changes.
Areas of Focus During Facial Examination:
- Skin Condition: Assess skin for color, texture, moisture, and temperature. Look for any lesions, such as moles, keratoses (like seborrheic keratoses or actinic keratoses), scars, or other skin growths. Note the location, size, shape, and characteristics of any lesions.
- Signs of Aging: Pay attention to:
- Wrinkling: Observe the depth and distribution of wrinkles, particularly around the eyes (crow's feet), mouth (marionette lines), and forehead.
- Blepharochalasia: Check for sagging or drooping of the eyelids due to excess skin.
- Skin Redundancy: Note any excess skin or sagging in the chin, neck (sometimes called "turkey neck"), upper neck, and jowls.
- Facial Symmetry: Evaluate the symmetry of the face. Note any asymmetry in facial features, such as the eyes, nose, mouth, or ears. Asymmetry can be a sign of underlying medical conditions.
- Underlying Structures: Palpate (gently feel) the facial bones and muscles to assess for any tenderness, masses, or irregularities.
- Facial Expression & Movement: Observe the patient's facial expressions for any abnormalities. Assess facial muscle strength and coordination by asking the patient to perform certain movements, such as smiling, frowning, and raising their eyebrows. This helps rule out conditions like facial nerve palsy (Bell's palsy).
Detailed Inspection Techniques:
- Visual Inspection: Start with a broad overview of the entire face, then focus on specific areas. Use good lighting to identify subtle changes.
- Palpation: Gently feel the skin and underlying structures to assess texture, temperature, and any palpable masses or tenderness.
- Assessment of Skin Lesions:
- ABCDEs of Melanoma: If you observe any moles, assess them using the ABCDE criteria:
- Asymmetry: One half doesn't match the other.
- Border: The borders are irregular, notched, or blurred.
- Color: The color is uneven, with shades of brown, black, red, white, or blue.
- Diameter: The mole is larger than 6 millimeters (about 1/4 inch).
- Evolving: The mole is changing in size, shape, or color.
- Refer any suspicious lesions to a dermatologist for further evaluation.
- ABCDEs of Melanoma: If you observe any moles, assess them using the ABCDE criteria:
- Documentation: Accurately document all findings, including the location, size, shape, and characteristics of any abnormalities. Photos can be helpful for tracking changes over time.
Important Considerations:
- Patient History: Take a thorough patient history, including any relevant medical conditions, medications, and family history of skin cancer or other facial abnormalities.
- Lighting: Use good lighting to ensure accurate assessment.
- Privacy: Maintain patient privacy and dignity during the examination.
- Cleanliness: Wash your hands before and after the examination.
By following these steps, you can conduct a thorough and informative examination of the face.
