Aging Changes of the Face
Michael Richard, MD
DISEASE DESCRIPTION
The aging process is universal, yet it is complicated, and the changes associated with aging are individual. The perception of aging remains even more individual still. The face, with associated concepts of youth and beauty, results from the interplay of several facial characteristics and proportions.
The sequence of the changes associated with aging is predictable, but the rate of the changes is variable and is dependent on genetic, anatomic, and environmental factors. In addition, within an individual, different anatomic subunits will age at varying rates. The aging process involves changes to individual anatomic structures in addition to changes in the proportions between one anatomic structure and the next. This contributes to the wonderful uniqueness we all possess but simultaneously makes understanding the aging process more complicated. For the aesthetic surgeon, a thorough understanding of the anatomic changes associated with the aging face is necessary before any attempts are made to adequately restore the youthful facial ideal.
AGING OF FACIAL STRUCTURES
Because facial anatomy is composed of three general elements — skin, soft tissue, and bone — it is important to understand the effects of aging on each of these.
Skin
Skin features provide a very subtle but very powerful aesthetic that can greatly affect one’s perception of chronologic age.
The skin texture dulls, becomes more coarse, develops fine and deep wrinkles, loses elasticity, and undergoes pigmentary changes with age, as a result of both intrinsic and extrinsic factors.
Intrinsic factors include hormonal and biochemical changes.
Extrinsic factors include such things as smoking, sun exposure, and gravity.
FIGURE 38.1. Aging changes of the skin. Thinning of the epidermis and subcutaneous layers, loss of organization of elastin and collagen, decreased sebaceous gland production, and hyperplasia of melanocytes manifest as wrinkles, dulling and drying at the surface, and pigmentary changes.
Specific skin changes seen with the aging process include the following (Figure 38.1):
Thinning of the epidermis and subcutaneous fat
Effacement of the dermal-epidermal junction with flattening of the rete ridges
Elastosis (accumulation of abnormal elastin in dermis with a loss of organization of the elastin and collagen fibers)
Keratinocytic dysplasia
Melanocytic hyperplasia
Decreased oil production from sebaceous glands
Soft tissues
Subcutaneous tissues shift as a result of gravity, causing drooping of many facial features including eyelids, nose, cheeks, and lips.
Fat atrophy
In general, subcutaneous fat atrophy causes a generalized loss of volume commonly described as deflation.
In specific areas, most notably the orbital, buccal, and temporal areas, fat atrophy causes a recognizable pattern of aging.
Decreased neurogenic tone in the mimetic muscles contributes to laxity and drooping of overlying soft tissues.
Bone
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