Clues to Facial Aging
Major forces responsible for facial aging include sun damage, smoking, gravity, soft-tissue aging, changes in facial muscular activity, and skeletal remodeling.
Characteristic signs of facial aging include:
- Greater visibility of tiny blood vessels in the skin, due to thinning of the dermis
- Greater visibility of bony landmarks, like jutting cheekbones or chins, secondary to facial fat involution
- Hollowing of the cheek and mouth area due to bone and dental loss, as well as volume depletion (loss of fat)
- Descent of facial fat pads due to gravity and deepening of the lines on the sides of the nose (nasolabial folds), and jowling
- Thinning lips and flattening of the central part of the upper lip (philtrum)
- Drooping corners of the mouth leading to loss of structure to support lip edges
- Drooping of the nasal tip
- Decreased support of the lower third of face
Youthful Brow vs Aging Brow
The brow of the young woman on the left is free of lines and wrinkles. The brow of the woman on the right demonstrates the parallel lines, forehead creases, and brow descent characteristic of aging.
Youthful Eyes vs Aging Eyes
The following photos of the 22-year-old woman on the left and her 51-year-old mother on the right are examples of the changes caused by aging.
The woman on the left has a smooth contour of the eyelid skin, whereas with aging there is excess upper eyelid skin, and depressions (nasojugal folds) and wrinkling giving an uneven appearance of the lower lids. Fat herniation and dark circles may also be present.
Youthful Lips vs Aging Lips
The lips of the woman in the left photo are a visible sign of youth. They are full bodied and smooth. Generally around 35 years of age, the lips will begin to flatten and thin out, the corners droop, and the lip lines begin to form. These changes are beginning to be evident in the photo of the woman on the right.
Youthful Mouth vs Aging Mouth
The mouth area shows dramatic change during the aging process. The photo of the young woman on the left demonstrates the volume of youth. In contrast, the photo of her mother on the right shows deepening of the nasolabial folds and corners of the mouth, as well as skin relaxation of the sides of the mouth.
Youthful Malar Area vs Aging Malar Area
The cheek contour and volume of the woman on the left are characteristic of youth. As early as 30 years of age, some descent of malar fat can be observed, which eventually leads to sagging of the jowl and deepening crevices (cheek). These characteristic changes of aging can be seen in the photo of her mother on the right.
Signs of Aging in the Upper Face
1. Brow descent
2. Hanging upper eyelids
3. Excess skin upper eyelids
4. Crow’s feet
5. Loss of support of the outer angle
6. Scleral show (excess show of the white of the eye)
7. Fat herniation, lower lids
8. Malar groove (depression outer lower eyelid)
9. Malar (cheek bone) hang
10. Nasojugal groove (depression inner lower eyelid)
Signs of Aging in the Lower Face
11. Nasolabial fold
12. Nasolabial groove
13. Hanging corner of the mouth
14. Lateral mandibular groove
15. Prejowl depression
16. Jowling
17. Loss of volume lower lip
18. Flattening of uper lip due to loss of volume
19. Chin crease
20. Loss of dental support
Facial Skin Aging
We begin to age the moment we are born, and the normal physiologic changes as we grow older can result in loss of volume (involution), or the progressive degeneration of the skin.
The combination of involution and thinning (aging) or the thickening (sun damage) of the skin often leads to skin problems, such as surface roughness and uneven contours of the face, sometimes called the “hills and valleys” of aging.
Extrinsic aging, caused by environmental damage, disease, or weight alteration, combined with intrinsic aging, caused by chronologic or ethnic factors, can result in a variety of skin imperfections. These imperfections (whether they are wrinkles, age or “liver” spots, acne scars, or other skin rhytids) may be uncomfortably noticeable. Today, a variety of different methods—including injections and physician-strength skin care products—can be used to produce smooth, clear skin and younger-looking facial contours.
Old Age = Lost Volume
We continue to lose volume in the face as we grow older—the flesh loosens and stretches and the wrinkles multiply.
Volume Loss
The aging process continues as the layer of fat under the dermis erodes and the muscles underneath the fat weaken and lose elasticity and tone.
These changes manifest themselves most notably as loss of volume (ie, thinning of the skin, drooping of mouth corners, jowling).
As We Age, Repetitious Muscle Movement Causes Wrinkles
Our emotions—anger, grief, happiness—are stamped on our face by the repetitious movement of our facial muscles. Over time, this can result in facial wrinkles.
Important muscles of the face include:
1. Frontalis: raises the eyebrows
2. Corrugator: draws eyebrow downward and medially
3. Procerus: forms a horizontal crease in the bridge of the nose
4. Orbicularis oculi: closes eyelids, aids passage and drainage of tears
5. Orbicularis oris: narrows mouth orifice, purses lips and puckers lip edges
6. Depressor Anguli Oris: pulls the corners of the mouth down causing marionette folds
7. Platysma: depresses the lower lip and forms ridges in the skin of the neck and upper chest
Muscle Activity and Horizontal Forehead Lines
When we’re surprised, puzzled, or alarmed, we tend to raise our eyebrows. The contraction of the frontalis muscle can, over time, result in permanent horizontal forehead lines.
Muscle Activity and Glabellar Frown Lines
The wrinkles between the brows—glabellar frown lines—are caused by the contraction of the corrugator and procerus muscles. As skin becomes less elastic over time, repeated contraction of the corrugator and procerus muscles may “crease” the skin, creating lines and wrinkles that are visible even when the muscles are at rest.
Muscle Activity and Crow’s Feet
Crow’s feet are caused by the movement of the orbicularis oculi. Over time, repeated contraction of this muscle may also create visible wrinkles—even at rest.
Muscle Activity and Perioral Lines
Perioral lines are the result of repeated contraction of the orbicularis oris sphincter of the mouth. They are exacerbated by the aging process and by smoking.
Muscle Activity and Mouth Frown
The depressor anguli oris pulls the corners of the mouth down causing marionette folds. Repeated contraction of this muscle leads to a permanent “sad” look.
Muscle Activity and Platysma Bands
The platysma depresses the lower lip and forms ridges in the skin of the neck and upper chest when the muscle contracts. Contraction of the platysma can convey the emotions of stress and anger.
Can We Use Fillers to Replace the Volumes Lost to Aging?
Yes. Today, instead of merely eliminating aging lines and crow’s feet, injections of filler substances may provide you with a fuller, more youthful-looking face with high contours and smooth skin. Injectable fillers can dramatically improve the angular, thin appearance that often accompanies age. Often BOTOX® Cosmetic is used in conjunction with facial fillers to achieve prolonged benefits.
Contact Us for More Information
For confidential personalized information and advice, please complete our information request form or call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .
The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, neck and chin surgery, rhinoplasty (nose surgery), surgery after massive weight loss, and tummy tucks. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, JUVEDERM™ Injectable Gel, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires.
