You look in the mirror and the reflection you gaze upon no longer looks like what you remember. For some this seems to happen overnight. For others it is a gradual process that at a certain point in time becomes undesirable. Friends or coworkers may have told you that you look tired but inside you feel like the same vibrant individual you have always been. Can you get that youthful healthy look back? Can you look as good as you feel? The purpose of this article is to explain the anatomic changes that occur in the face with aging so you can address what you feel is important.
Aging happens at different rates for all individuals. The process may be accelerated with environmental stimulants such as excessive sun exposure, cigarette smoke, and poor nutrition. Aging is not skin deep: it is deeper. The process affects the skin, the underlying fat, muscle and bone of the face.
The skin consists of two basic layers: the outer epidermis that protects the body from the environment, and the inner dermis that holds the elasticity of the skin. When the skin is youthful the epidermis is thin and smooth relative to the dermis. The dermis holds the skins organs and its elastic fibers such as collagen and elastin. As the skin ages, the epidermis tends to get thicker and the dermis thinner. The dermis is the skins foundation and it loses some of its collagen and elastin. Thus the skin begins to form wrinkles and have less elasticity. This means it does not snap back like it used to.
Below the skin are a variety of thicknesses of fat that cover and surround a multitude of layers of muscles, nerves, and blood vessels. The fat is separated into multiple different compartments throughout the face and each compartment ages differently. Some compartments tend to decrease in size while others increase and some remain the same. Fat regions that decrease in size tend to produce characteristic hollowing of the aged face. These are located in the temples, in the cheeks and in the chin. As they sit next to areas that may stay the same or increase, this accentuates what patients see as the jowl, parentheses lines (nasolabial folds), and marionette folds.
Superficial muscles in the face surround the eye and form a covering throughout the neck. These muscles tend to sag and elongate with time. This can produce the characteristic aging changes around the eye and in the neck. In fact in the neck, the bands that people see as they enter their mid forty’s and become exaggerated in their fifties and sixties are caused by the large flat platysma muscle loosening from the deeper structures of the neck.
Even the bones in the face change as we age. We lose bone throughout areas of the facial skeleton. This is seen in the orbit, the bones that hold the eyes in position, and in the maxilla, the bones in the central portion of the face. As a result, the older a patient gets, the more the eyes sit farther back in the eye sockets and the bones around the nose and mouth shrink.
Aging of the face therefore causes wrinkling in the skin, decreased elasticity in the skin, shrinkage of some fat compartments and an apparent prominence of other fat compartments, muscle laxity and loss of bone. When you are youthful, the envelope that forms the outward appearance of your face has a certain surface area and volume. It is also elastic. As we age the outer surface area remains the same but it loses its elasticity and the inner volume shrinks. The result is that the outer envelope begins to sag and we interpret that as the signs of aging.
To create a natural youthful appearance, the plastic surgeon must address the individual issues that each unique face presents. Skin quality, fat volume, muscle redundancy and bone loss should all be appropriately evaluated and addressed to create an anatomically correct rejuvenation.