The Anatomy of Facial Aging-What’s Happening to My Face?

Recently, we discussed why more and more Baby Boomers are undergoing cosmetic procedures to reverse the signs of aging. This month, we’ll discuss the “Anatomy of Facial Aging” to better elucidate the causes of those bothersome changes one may experience as you age.

The Certainties of Aging

The aging process involves the complex interplay of several
key elements including diet, exercise, sleep, genetics, environmental factors (sun exposure, wind damage), and tobacco use, to name a few. Despite our best attempts to alter these variables, the certainty remains – aging will inevitably occur. When it comes to facial aging, there exists several predictable transformations to the tissues of the face, which include the skin, muscle, fat, bone, and  retaining ligaments.

Skin
Aging skin loses key structural components which contribute to its strength (collagen), elasticity (elastin), and hydration (hyaluronic acid). Aged skin thus becomes dryer, thinner, less elastic, less voluminous, and more likely to wrinkle or sag, such as occurs with excess skin of the upper eyelids or the neck.

Muscle
The muscles around the face and eyes may become more hyperactive and contribute to excess wrinkles or puffiness. Alternatively, the muscles of the face may weaken and atrophy, which contributes to a deflated look and decreases support for the rest of the facial soft tissues.

Retaining Ligaments 
Facial ligaments provide structural support for the superficial soft tissues of the face. These ligaments, which originate from the bone and attach to the skin and overlying fat pads, weaken over time, and thus contribute (with the help of gravity) to the sagging skin and fat we see with aging.

Fat
The most recent and relevant research regarding the anatomy of facial
aging pertains to the understanding of facial fat pads. In short, the facial fat pads are partitioned into separate compartments and exist in two distinct layers (superficial and deep), both of which contribute to the overall balance of the face. In short, some areas lose fat, such as the cheeks and the temples, which creates a hollow and deflated look. On the other hand, some areas gain fat, such as around the mouth and the jaw, which contribute to the so-called “nasolabial folds” and “jowls”. Lastly, some fat pads become more visible as they protrude from their intended position due to adjacent structural defects, such as occurs with herniated orbital fat creating lower eyelid bags. Overall, this errant redistribution of the facial fat pads leads to the creation or worsening of folds, shadows, and other contour irregularities that embody the telltale signs of aging.

Bone
We experience a significant loss of facial bone with aging. Without the structural support of the bone, the overlying soft tissues (skin, muscle, fat) also display noticeable changes such as hollowing of the eyes, temporal wasting, cheek deflation, and poor jawline definition. In short, the progressive loss of fat and bone represents a key contributor to the facial aging process. Therefore, I often recommend re-volumizing the face with either dermal fillers or facial fat grafting to anybody contemplating a facelift or other facial rejuvenation procedure. I can’t say it enough, but volume replacement is key!

What can I do to combat the facial aging process?
First, relax. Aging is normal and beautiful, so embrace it for everything it means to you. Second, one must recognize that the changes in balance, proportion, and symmetry associated with the aging face are unique to each patient, and thus a customized treatment plan remains paramount to achieve optimal results. Next, you should consult with a physician who has specialty training in the area you are looking to improve, and who may recommend treatments ranging from non- invasive modalities (e.g., botulinum toxin, fillers, lasers, chemical peels) to more advanced surgical options (e.g., facelift, brow lift, fat grafting, eyelid surgery. rhinoplasty).

Lastly, choose a surgeon whom you trust.
There are few things more important than
your relationship with your doctor.
In Good Health,

Blake Raggio, M.D
Double Board Certified Facial Plastic Surgeon

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