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Facial aging is not just a skin problem. There are complex relationships between the skin, soft-tissue, and underlying skeleton which culminate in the aging face. We now know that the facial skeleton changes significantly as we age. Over time, the bony framework around the eyes, cheeks, nose, and jaw change shape and size. The orbit (bone around the eye) shifts, rotates, and recedes. The maxilla (midface) demonstrates resorption and decreased anterior projection. The bony borders of the nose widen and deepen. The jaw decreases in vertical and horizontal demensions due to bony loss. The changes in the midface and jaw are accelerated with loss of dentition. The result is hollowing around the eyes, loss of cheek projection, changes in nasal shape and position, and weakening of the chin and jaw. This loss of skeletal support changes how the overlying skin and soft-tissue is draped.
It is important to understand and assess these changes when discussing how to restore the aging face. All-too-often, the focus is on the skin and soft-tissue, as this is the most visible aspect. Likewise, a thorough home restoration involves improvement in the framework of the home, not just applying a new coat of paint.
For the most part, these bony changes are unavoidable, and the bone cannot be restored. However, there are ways to make up for these losses. We can camouflage these changes with permanent facial implants or semi-permanent fillers. Fat grafting can be used to increase the volume of the overlying soft-tissue. More to come on options for treating these changes. For now, it is enough to at least appreciate the many factors that contribute to facial aging.