Two decades of healthy growth, followed by four to eight decades of slow-motion physical and mental collapse—that’s life, for most of us. Time spares nothing, and seems particularly to have it out for our faces, paying just as much attention to skin-level deformations (worry-lines, wrinkles, tumorous outgrowths) as it does to the large-scale hollowings and saggings which, over time, change the actual shape of our faces.

To varying degrees we’re all marked by time, or will be soon. We can’t reverse this process, but we can try to understand it. It’s interesting to note why our faces change shape as we age. As it turns out, what some people think of as “facial weight gain” might in fact be something else—and that is, sad to say, not even the half of what’s in store for nearly all of us.

Facial aging, and changes to bone, skin, and soft tissue are, in part, genetically predetermined. “Wear and tear” and environmental exposures are also factors. In a young person, the cells comprising facial tissues are spry, and there are clearly defined compartments with intact attachments holding skin and facial structures in the appropriate locations. The appearance of tight skin, developed cheekbones, well-defined contours—with contrasting plump areas and subtle depressions —is what defines a youthful face. With age and time, these boundaries start to stretch and lose integrity, which leads to fat pad displacement, or blending into areas where fullness didn’t exist before (e.g., jowls), and descent of skin and soft-tissue of the face. It’s almost akin to wax melting, and with gravity the structures are “dripping” or migrating downwards.

In terms of rejuvenation and correction of the aging face, we recognize that a youthful face is actually a well-supported face, with appropriate fullness and hollows (light reflexes and shadows on photographs), without the sagging or tissue spilling/descent we see with aging. In some areas the fat atrophies (shrinks away) and creating hollows (for instance around the eyes).

What are some of the most common effects of aging on the face?

Beginning at the forehead and eyebrow area, due to prolonged muscle action attached to the skin, obvious horizontal creases and wrinkles develop, and vertical creases (like a “#11”) from between the eyebrows, giving an aged appearance. The eyebrows themselves begin to sag down closer to the eyelids; and the skin around the eyelids becomes bunched (stretched and redundant) hanging over the eyelashes and blocking vision. This dermatochalasia obliterates the crisp eyelid crease, and gives an old and tired appearance. The lower eyelid skin looks more like crepe paper, with dark circles forming, and an obvious crease between the lid and cheek (lid-cheek junction).

The fat compartments of the face, usually held back by retaining ligaments, begin to push out and migrate into lower areas. For instance, cheek fat comes down and collects underneath the nose and above the lips (forming deep “nasolabial” folds), and making the cheekbones look less defined. The skin and fat lower in the face herniates below the jawline, behind the chin. Below the chin, going toward the neck, a thin muscle (platysma) spreads apart, forming “bands,” and fat herniates through and the skin hangs off – giving the “turkey-gobbler” appearance.

In addition to facial ligaments loosening, and the skin losing elasticity and sagging, the bone changes as well. The facial skeleton is a biologic system, undergoing regular remodeling. Osteoporotic changes, and bone resorption can be a component of aging. Loss of teeth is a problem too—resulting not only in less lip and facial tissue support, but accentuating bone resorption of the alveolus (arches of the jaws). In the upper jaw (maxilla) bone shrinks away in an “up and back” direction, whereas in the lower jaw (mandible), this occurs “down and forward.” This gives way to the “toothless” elderly appearance (when you see a grandparent without their dentures). The chin/mandible looks more prominent and over-closes, while the maxilla is recessed and the lips flop inward (unsupported).

Facial aging is a normal biologic process and differences exist based on gender, geography, exposures, disease, and upkeep. The diversity of the human face, and anthropologic differences, in-and-of themselves are normal and beautiful. However, the ability to alter facial aging (biochemically, surgically, genetically), is the here-and-now, and can improve function and alter our human experience.