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 deluded cranks and tech billionaires. Time spares nothing, and seems particularly to have it out for our faces, paying just as much attention to skin-level deformations (worry-lines, wrinkles, tumorous outgrowths) as it does to the large-scale hollowings and saggings which, over time, change the actual shape of our faces.
To varying degrees we’re all marked by time, or will be soon. We can’t reverse this process, but we can try to understand it. To that end, we reached out to a number of ageing experts and plastic surgeons to figure out why our faces change shape as we age. As it turns out, what some people think of as “facial weight gain” might in fact be something else — and that is, sad to say, not even the half of what’s in store for nearly all of us.
Derek M. Steinbacher
Associate Professor, Plastic Surgery, Director of Craniofacial, and Chief of Oral and Maxillofacial Surgery, Yale
Facial ageing, and changes to bone, skin, and soft tissue are, in part, genetically predetermined. “Wear and tear” and environmental exposures are also factors. In a young person, the cells comprising facial tissues are spry, and there are clearly defined compartments with intact attachments holding skin and facial structures in the appropriate locations. The appearance of tight skin, developed cheekbones, well-defined contours — with contrasting plump areas and subtle depressions — is what defines a youthful face. With age and time, these boundaries start to stretch and lose integrity, which leads to fat pad displacement, or blending into areas where fullness didn’t exist before (e.g., jowls), and descent of skin and soft-tissue of the face. It’s almost akin to wax melting, and with gravity the structures are “dripping” or migrating downwards.
In terms of rejuvenation and correction of the ageing face, we recognise that a youthful face is actually a well-supported face, with appropriate fullness and hollows (light reflexes and shadows on photographs), without the sagging or tissue spilling/descent we see with ageing. In some areas the fat atrophies (shrinks away) and creating hollows (for instance around the eyes).
What are some of the most common effects of ageing on the face?
Beginning at the forehead and eyebrow area, due to prolonged muscle action attached to the skin, obvious horizontal creases and wrinkles develop, and vertical creases (like a “#11”) from between the eyebrows, giving an aged appearance. The eyebrows themselves begin to sag down closer to the eyelids; and the skin around the eyelids becomes bunched (stretched and redundant) hanging over the eyelashes and blocking vision. This dermatochalasia obliterates the crisp eyelid crease, and gives an old and tired appearance. The lower eyelid skin looks more like cray paper, with dark circles forming, and an obvious crease between the lid and cheek (lid-cheek junction).
The fat compartments of the face, usually held back by retaining ligaments, begin to push out and migrate into lower areas. For instance, cheek fat comes down and collects underneath the nose and above the lips (forming deep, nasolabial, folds), and making the cheekbones look less defined. The skin and fat lower in the face herniates below the jawline, behind the chin. Below the chin, going toward the neck, a thin muscle (platysma) spreads apart, forming bands, and fat herniates through and the skin hangs off — giving the “turkey-gobbler” appearance.
In addition to facial ligaments loosening, and the skin losing elasticity and sagging, the bone changes as well. The facial skeleton is a biologic system, undergoing regular remodeling. Osteoporotic changes, and bone resorption can be a component of ageing. Loss of teeth is a problem too — resulting not only in less lip and facial tissue support, but accentuating bone resorption of the alveolus (arches of the jaws). In the upper jaw (maxilla) bone shrinks away in an “up and back” direction, whereas in the lower jaw (mandible), this occurs “down and forward.” This gives way to the “toothless” elderly appearance (when you see a grandparent without their dentures). The chin/mandible looks more prominent and over-closes, while the maxilla is recessed and the lips flop inward (unsupported).
Facial ageing is a normal biologic process and differences exist based on gender, geography, exposures, disease, and upkeep. The diversity of the human face, and anthropologic differences, in-and-of themselves are normal and beautiful. However, the ability to alter facial ageing (biochemically, surgically, genetically), is the here-and-now, and can improve function and alter our human experience.
Assistant Professor, Surgery, Yale University
Essentially there are fat compartments distributed throughout the face — around your cheekbones, around your frown-lines, around your mouth. Those fat compartments are maintained by these ligaments that are essentially going from the bone in your facial skeleton to the skin. As you age these fat compartment start to descend — they go lower — so if you actually evaluate a patient chronologically, from their twenties and thirties up to their fifties and sixties, you find that their facial fat descends to the lower portion of their face. For that reason, patients’ faces tend to look longer as they grow older.
The other thing that happens is that, even though your skin and your fat descent, those ligaments still are retained from the bony surfaces of your facial skeleton, and so those prominent lines you find around your mouth, or that fold between your nose and your mouth, become more indented and obvious as laxity increases on the rest of your skin. But those parts of the bone are fixed and firm and so they become more dramatic as you age. They essentially look like very coarse wrinkles because of the fact that they’re still attached to the bony undersurface.
Associate Professor, Plastic Surgery, NYU School of Medicine
Our faces change primarily due to the soft tissue or fat component in our faces.
If you look at the faces of young people, regardless of weight, their faces are full and full of convexities! As we age the fat in our faces dissipates and also descends southward or down due to ageing of the structures and gravity. The bony component remains stable but all of the rest ages and changes. We typically see noses that look longer and hence bigger, this is due to drooping of that structure, ear lobules that are longer and hanging, and the same phenomenon with the jawline and the chin even! In the midface we see prominent high cheekbones look lower and less defined. Usually lips thin out a bit as well. All these factors influence the shape and appearance of the face.
Assistant Professor, Plastic Surgery, Emory University Hospital and Grady Memorial Hospital
Facial ageing is a combination of multiple processes. First, there is the skin itself. The skin itself atrophies (the dermis thins), there are fewer fibroblasts, mast cells and blood vessels and elastic fibres with ageing. The skin becomes more prone to wrinkling and sagging, and fine lines start to become deeper, especially the areas with facial animation — the forehead, between the eyebrows, the corners of the eyes, and around the mouth.
Over time, our skin suffers damage (mostly from sun exposure and lifestyle choices such as smoking), which leads to wrinkles, dark spots, and even tumours. Sun damages the elastic fibres and causes them to accumulate in abnormal arrangements. The number of collagen fibres decrease and the remaining fibres become disorganized. A thin layer of dermis called the green zone forms between the abnormal dermis (deeper layer of skin) and epidermis (top layer of skin).
Loose skin becomes noticeable often with lowering of the brows, under the chin, jowls, and eyelids. As the tissue becomes weaker, it stretches. The facial fat also atrophies and descends due to chronic exposure to gravity. This can be noticeable in the temple areas, which can become hollow, or the eyes, which look sunken in. The malar (cheek) fat pad descends and cheeks look sunken in, nasolabial folds deepen, and jowls develop.
Professor, School of Ageing Studies, University of South Florida
There are obvious and visible changes to the epidermis, the main layer of the skin, that make the skin less flexible. The process is referred to as cross-linking and it involves more rigid/less flexible bonding across molecules of collagen and elastin. This is magnified by thinning of the skin and by the fact that facial muscles continuously contract, particularly during periods of concentration or emotional arousal (stress), making wrinkles appear larger over time.
When it comes to the shape of the face, the main players are the bones and connective tissues. Bones, in particular, are quite dynamic. Over time, they do not rebuild themselves as well, leading to overall reduction in mass, which can lead to differences in the shape of face. Eye sockets enlarge and lower jaw decreases in length and height. Connective tissue in the nose and some changes in the angle make the nose appear larger.
Christopher B. Forrest
Professor and Chair, Plastic and Reconstructive Surgery, University of Toronto and Medical Director, The Centre for Craniofacial Care and Research
It boils down to intrinsic and extrinsic factors. Good genes are the intrinsic ones, smoking and sun exposure are the factors we can control. Physiologically, as we age, our faces lose fat, our elastin collagen fibres degrade and the bones of the face erode a bit. All that adds up to ageing. It’s a pretty complex and fascinating process, one which we as Plastic and Reconstructive Surgeons think we can hold back with surgery of various types — though I suspect we just make the face look different.
Dr. Leonard Guarente
Director of the Glenn Center for Biology of Ageing Research at MIT and Elysium Health Chief Scientist
Ageing is accompanied by a loss of subcutaneous fat and a weakening of skeletal muscle termed sarcopenia. Both of these can give an older, saggy appearance to facial features, and, more importantly, lead to a decline in physical strength and tone.
This article was originally published in March 2018.