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Anatomy and physiology of the aging face

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

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

But gravity, bone movement and facial muscle movement begin to change the structural appearance.

This natural and uncontrollable ageing process affects our facial structure over time.

Anatomy of the face

Our face is made up of the following structures:

  • skin
  • bone
  • muscle
  • fat pads

Anatomically as our skin ages, the following things happen:

  • collagen production our internal scaffolding slows down
  • production of elastin decreases, which gives our skin bounce back
  • fat cells start to diminish – resulting in sagging skin on your face
  • your 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 dull, sallow skin tone

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

How skin ages

If you were to look under a microscope, it is possible to see cellular age-related changes such as epidermal thinning, collagen loss and dermal-epidermal junction flattening.

Your skin loses its natural elasticity and bounce, 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 elastin and collagen organisation becomes disorganised, causing a loss of volume; this along with the repeated activity of your muscles leads to the formation of rhytides over muscle contraction regions, such as the orbicularis oculi and oris muscles, which causes ageing around the eyes and mouth.

Smoking, photo-damage and environmental factors contribute to increased intracellular reactive oxidative species, a subject we discuss in detail 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 your skin’s surface, caused by increased production of melanin due to excessive sun exposure.

Changes in skin volume

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

Due to ageing, the subcutaneous fullness of the following areas to be lost:

  • brows
  • upper eyelid region
  • forehead region
  • the temple

This is what makes the bony structure of your 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, visibly ageing your face.

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

Changes in shape

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

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

Midface aging

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 midface area’s fat pads 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 aging

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


As you 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 your face.

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