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, despite the efforts of various misguided lunatics and tech billionaires. Time spares nothing and seems mostly out on our faces, paying just as much attention to deformities at the skin level (care lines, wrinkles, tumor outgrowths) as to the large-scale hollows and sagging that, over time, alter the actual shape of our faces.
We are all, to varying degrees, marked by time or soon will be. We cannot reverse this process, but we can try to understand it. To that end, we contacted some aging experts and plastic surgeons to discover why our faces change shape as we age. It turns out that what some people think of as “facial weight gain” maybe something else — and that’s, sad to say, not even half of what lies ahead of nearly all of us.
We asked some experts to explain this.
Derek M. Steinbacher
Associate Professor of Plastic Surgery, Director of Craniofacial and Chief Maxillofacial Surgery, Yale
The face. Facial aging and bone, skin, and soft tissue changes are partly genetic. “Wear” and environmental exposure are also factors. In a young person, the cells that make up facial tissues are sparse, and there are clearly defined compartments with intact attachments that keep skin and facial structures in the correct locations. The appearance of tight skin-developed cheekbones and well-defined contours – with contrasting plump areas and slight depressions – defines a youthful face. With age and time, these boundaries begin to stretch and lose their integrity, leading to the displacement of the fat pad or mixing with areas where fullness previously did not exist (e.g., cheeks) and reduction of skin and soft tissue of the skin. It is almost like melting wax; with gravity, the structures “drip” or migrate downwards.
Regarding rejuvenation and correction of the aging face, we recognize that a youthful face is a well-supported face, with proper fullness and voids (light reflexes and shadows in photos), without the slackening or run-off of tissue we see in aging. In some places, the fat decreases (shrinks away), and cavities form (for example, around the eyes).
What are some of the most common effects of aging on the face?
Starting at the forehead and eyebrow area, due to prolonged muscle action attached to the skin, distinct horizontal folds and wrinkles develop, and vertical folds (like a “#11”) between the eyebrows, giving an aged appearance. The eyebrows begin to sink closer to the eyelids, and the skin around the eyelids bunches up (stretched and excess), hangs over the eyelids, and blocks the view. This dermatochalasis destroys the sharp eyelid crease and gives an old, tired look. The skin of the lower eyelid looks more like chalk paper, with dark circles and a distinct crease between the eyelid and cheek (lid-cheek transition).
The fat compartments of the face, usually held back by holding onto ligaments, begin to push outward and migrate to lower areas. Cheek fat, for example, comes down and collects under the nose and above the lips (forming deep, nasolabial folds), making the cheekbones look less defined. The skin and fat lower in the face herniated below the jawline, behind the chin. Under the chin, toward the neck, a thin muscle (platysma) spreads out, forms bands and fat hernias through, and the skin sags – creating the “turkey gulp” appearance.
Besides the loosening of the facial bands and the loss of elasticity and sagging of the skin, the bone also changes. The facial skeleton is a biological system that is regularly remodeled. Osteoporotic changes and bone resorption can be part of aging. Tooth loss is also a problem – resulting in less support of lip and facial tissue and accentuating bone resorption of the alveolus (jaw arches). In the upper jaw (maxilla), the bone shrinks in an “up and back” direction, while in the mandible (mandible), it shrinks “down and forward”. This gives way to the “toothless” appearance of an elderly person (when you see a grandparent without their dentures). The chin/lower jaw looks more prominent and closes too close, while the upper jaw is recessed, and the lips fold in (unsupported).
Facial aging is a normal biological process, and differences exist based on gender, geography, exposure, disease, and maintenance. The diversity of the human face and anthropological differences are normal and beautiful. However, the ability to alter facial aging (biochemically, surgically, genetically) is here and now and can enhance function and transform our human experience.
“If you look at the faces of young people, regardless of their weight, they are full and full of convexities!”
Assistant Professor, Surgery, Yale University
Essentially, fat compartments are distributed all over the face – around your cheekbones, frown lines, and mouth. Those fat compartments are maintained by these ligaments that go from the bone in your facial skeleton to the skin. As you get older, this fat compartment starts to decrease — they get lower — so if you evaluate a patient chronologically, from twenty and thirty to fifty and sixty, you see that their facial fat goes down to the lower part of their face. For that reason, patients’ faces tend to look longer as they age.
The other thing that happens is that, even though your skin and your fat descend, those ligaments still hold off the bony surfaces of your facial skeleton. Thus those prominent lines you find around your mouth, or that crease between your nose and your nose. mouth, become indented and more apparent as the laxity on the rest of your skin increases. They essentially look like very coarse wrinkles due to the fact that they are still attached to the bony underside. But those parts of the bone are solid, so they get more dramatic as you get older.
Associate Professor, Plastic Surgery, NYU School of Medicine
Our faces change mainly due to the soft tissue or fat component in our faces.
If you look at the faces of young people, regardless of their weight, they are full and full of convexity! As we age, the fat in our face disappears and descends to the south or downwards due to the aging of the structures and gravity. The bony component remains stable, but the rest ages and changes. We usually see noses that appear longer and, therefore, larger due to the drooping of that structure, long and floppy earlobes, and the same phenomenon even with the jawline and chin! In the center of the face, we see prominent high cheekbones that appear lower and less defined. Usually, the lips also become a bit thinner. All these factors affect the shape and appearance of the face.
Assistant Professor, Plastic Surgery, Emory University Hospital, and Grady Memorial Hospital
Facial aging is a combination of several processes. First, there is the skin itself. The skin itself atrophies (the dermis becomes thinner), there are fewer fibroblasts, mast cells and, blood vessels, and elastic fibers with age. The skin becomes more prone to wrinkles and sagging. Fine lines deepen, especially the facial animation areas – the forehead, between the eyebrows, the corners of the eyes, and around the mouth.
Over time, our skin suffers damage (usually from sun exposure and lifestyle choices like smoking), leading to wrinkles, dark spots, and tumors. Sun damages the elastic fibers and causes them to accumulate in abnormal arrangements. The number of collagen fibers decreases, and the remaining fibers become disorganized. A thin layer of the dermis, called the green zone, forms between the abnormal dermis (deeper layer of skin) and epidermis (upper layer of skin).
Loose skin is often noticeable at the lowering of the eyebrows, under the chin, cheeks, and eyelids. As the tissue weakens, it stretches. Facial fat also decreases and drops as a result of chronic gravity exposure. This may be noticeable in the temple areas, which may become hollow, or the eyes, which appear sunken. The malar (cheek) fat pad descends, and cheeks appear open; nasolabial folds deepen, and cheeks develop.
Professor, School of Aging Studies, University of South Florida
There are clear and visible changes to the epidermis, the skin’s main layer, which makes the skin less flexible. This is exacerbated by the thinning of the skin and by the fact that facial muscles contract collagen and elastin molecules during periods of concentration or emotional arousal (stress), making wrinkles appear larger over time. The process is called cross-linking and involves a more rigid/less flexible bond between molecules of collagen and elastin.
Regarding the shape of the face, the main players are the bones and connective tissues. Bones, in particular, are quite dynamic. Over time, they don’t rebuild themselves as well, leading to an overall decrease in mass, which can lead to differences in the shape of the face. Eye sockets enlarge, and the lower jaw decreases in length and height. Connective tissue in the nose and some changes in angle make the nose appear larger.
“We can hold back with different types of surgery — although I’m guessing we’re just making a face look different.”
Christopher B. Forrest
Professor and Chair, Plastic and Reconstructive Surgery, University of Toronto and Medical Director, The Center for Craniofacial Care and Research
It comes down to intrinsic and extrinsic factors. Good genes are innate, and smoking and sun exposure are the factors we can control. Physiologically speaking, as we age, our faces lose fat, our elastin collagen fibers degrade, and the bones of the face erode a little. All of that contributes to aging. It’s quite a complex and fascinating process, which we, as plastic and reconstructive surgeons, think we can stop with different types of surgery – although I suspect, we’re just making a face look different.
Dr. Leonard Guarente
Director of the Glenn Center for Biology of Aging Research at MIT and Elysium Health Chief Scientist
Aging is associated with a loss of subcutaneous fat and a weakening of skeletal muscles, also known as sarcopenia. Both can give an older, saggy appearance to facial features and, more importantly, lead to a decrease in physical strength and tone.
There you have it!
This article has been updated since it was first published.