Aging of the facial skeleton

• Visible changes in the aging face (such as jowls, sagging, crow’s feet) are, in part, due to thinning skin that has lost its intrinsic elasticity and nonuniform loss of subcutaneous fat.

• The bony skeletal provides the framework on which the skin, subcutaneous fat, and muscle layers create the overall three-dimensional facial contour.

• The aging facial skeleton undergoes predictable resorption of bone, most notably an increase in the volume of the bony orbit, retrusion of the maxilla, and decrease in size of the mandible.

• Better understanding of these changes can help direct rejuvenation efforts.

Introduction

The characteristics of the aging face are a combination of structural changes on many levels. The most visible layer, the skin, comprises a variety of cells, including keratinocytes, collagen, and elastin, which produce the nonuniform thickness of the epidermis and the dermis. The alteration and decrease in the number of these cells produces the thin and atrophic appearance of the aging face. The underlying subcutaneous layer is also nonuniform in thickness, and the predictable losses in specific locations make the separating “lines” of retaining ligaments more visible with aging. Traditionally, facial rejuvenation techniques have focused on the restoration of the skin and soft tissue deficiencies with lasers, lifting, fillers, and/or fat grafting. However, for facial rejuvenation to achieve its maximum benefit, it must address all anatomic components of the aging face.

Specifically, the bony skeleton undergoes unique and predictable changes. For some patients, this may represent the primary contribution to their aging appearance. The areas most impacted by resorption of bone include the superomedial and inferolateral bony orbit, the glabellar and maxillary angle of the midface, and the mandibular body and angle measurements. ^, Better understanding of the location and timing of these bone changes can provide a more specific approach to correcting the aging face.

Skeletal changes

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