Anatomy and Physiology of the Aging Face

Do you look in the mirror and see furrows, fine lines and wrinkles appearing?

When we are young our face manifests as one single dynamic unit with smooth facial contours.

Over time the effects of gravity, bone movement and the constant activity of facial muscles begin to change the structural appearance of our face.

This natural and uncontrollable ageing process is called extrinsic and intrinsic ageing, which affects the facial structure over time.

Anatomy of the face

It’s frustrating I know, but in order to know how to treat mature skin, it’s important to understand how our skin ages.

Our face is made up of the following structures:

  • Skin
  • Bone
  • Muscle
  • Fat pads

Changes in the skin

Anatomically as skin ages, the following things happen:

  • collagen production our internal scaffolding slows down
  • production of elastin decreases, which gives the skin bounce back
  • fat cells start to diminish – resulting in sagging skin
  • the skin’s ability to retain moisture decreases and it becomes dehydrated
  • frown lines appear due to the repetitive contraction of the small muscles
  • cellular turnover slows down – leading to a dull appearance in skin tone

The most visually prominent age-related changes in the skin result from chronic exposure to the sun, leading to hyperpigmentation – changes in colour, tone and texture, causing lines and wrinkles, which are all a result of photo-ageing.

Skin ageing

If you were to look under a microscope it is possible to see cellular age-related changes. Epidermal thinning, collagen loss and dermal-epidermal junction flattening can all be seen.

The skin loses its natural elasticity and bounce back, it becomes dehydrated as an increase in transepidermal water loss occurs.

Dry skin is due to both reduced water-binding capacity and decreased activity of the sebaceous glands.

The organisation of elastin and collagen becomes disorganised causing a loss of elasticity and volume. This along with the repeated activity of muscles leads to the formation of rhytides over muscle contraction regions such as the orbicularis oculi and oris muscles, causing ageing around the eyes and mouth.

Smoking, photodamage and environmental factors contribute to the increase in intracellular reactive oxidative species, a subject I discuss here. This results in multiple skin changes that lead to characteristics that are consistent with skin ageing. This is accompanied by hyperpigmentation – age spots on the skin’s surface, which is caused by increased production of melanin due to excessive sun exposure.

Changes in volume

A young face is characterised by healthy filled facial fat compartments in the correct places.

Due to ageing, the subcutaneous fullness of the upper eyelid region, brows, forehead region, brows, the temple is lost. This is what makes the bony structure of the skull, brow muscles and temporal blood vessels more pronounced. Fat redistribution and atrophy also cause loss of facial volume.

Interestingly, some facial areas lose fat such as the forehead and cheeks, whilst other areas can actually gain fat such as the mouth and jaw, these changes in fat pads cause contour deficiencies, ageing the face.

The zygomatic muscles in the cheek area and mandibular around the jawline create a drooping appearance to the soft facial tissues, which contribute to the appearance of the tear trough, jowls. The decrease in the normal subcutaneous fat compartments of the face causes an increase in skin laxity and the distinctive folds that appear around the nose and jowl area.

Changes in shape

The shape of the face is determined by the underlying muscles and supporting structures of the face the ligaments.

These ligaments stabilise the youthful face, but the constant activity of facial muscles combined with intrinsic ageing changes, causes these ligaments to become weak and this progressive lack of structural support for the face, combined with the pull of gravity leads to soft facial tissue and the drooping appearance we associate with ageing.

The aging face

Let’s take this one step further and break the face down into three distinct areas, you can begin to get a profile of the ageing process a technique referred to in the industry as face mapping.

Upper face aging
Skin: This area loosens and dehydrates, resulting in the formation of frown lines, forehead wrinkles and crow’s feet
Fat pads: Loss of volume in fat pads create hollowing around the eyes and temples, which can cause eyebrows to become lower.
Bone: Bone loss causes hollowing around the eyes and temples.
Muscles: Repetitive movement creates lines at rest in the frown area, forehead and crow’s feet.

Treatment options

  • Forehead lines
  • Frown lines
  • Eyebrows
  • Temple hollowing
  • Skin rejuvenation
  • Crow’s feet

Mid face ageing
Skin: Midface volume loss, creates lines under the eyes and nose to mouth lines, which become deeper over time.
Fat Pads: Loss of volume in the fat pads of the midface area, accentuates tear troughs and nose to mouth lines.
Bone: Bone loss in the cheek area, accentuates mid-face flattening.
Muscle: Repetitive movement, this creates lines at rest in the midface

Treatment options

  • Tear troughs
  • Cheek enhancement
  • Nose to mouth lines
  • Nasal bridge improvement
  • Skin rejuvenation
  • Acne scar improvement

Lower face ageing
Skin: Loosens and dehydrates, creating lines around the mouth and chin.
Fat Pads: Volume loss in the fat pads, combined with gravity creates jowls and lower facial lines.
Bone: Bone loss along the jawline accentuates jowls.
Muscles: Repetitive movement creates lines around the mouth, chin and lower face.
Lips: Lip volume decreases with age.
Bone: Bone loss causes lips to appear inverted.
Muscle: Repetitive movement creates lines around the mouth, chin and lower face.

Treatment options

    • Lip volume
    • Lip border
    • Lip lines
    • Lower necklines
    • Chin enhancement
    • Jawline enhancement
    • Skin rejuvenation
  • Acne scar improvement
  • Neck
  • Decollete
  • Hands

The naked truth

As we can see the combination of visibly apparent skin changes as well as underlying structural disparities, involving bone, muscles, fat and ligaments is responsible for the ageing appearance of the face.

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