Unit 1: Age-Related Anatomical Changes

Facial aging is a multifactorial process that affects different interconnected structures. These include:

• Bone resorption and remodelling
• Muscle tone and atrophy
• Fat loss and redistribution
• Dermal aging and collagen loss

Bone Resorption:

There is a significant loss of facial bone with age; this usually starts from age 40. Ageing of the craniofacial skeleton may be due to changes in the relative dynamics of bone expansion and bone resorption (osteoclast activity higher than that of osteoblast cells). Common age-related changes to the skull include:

• Widening of the orbit and reduction in the angle of the bones beneath our eyebrows leading to the formation of frown lines the forehead, crow’s feet and droopy lower eyelids.
• Reductions in the angles of the nose and upper jaw bones.
• Reduction in the length and height of the lower jaw.

Without the structural support of bone, there are noticeable changes in the other layers of overlying soft tissue and skin.

Muscle Tone & Atrophy:

As we age, the natural tendency of facial muscles is to become atrophic and contracted, due to the amount of facial expressions made over the years. This is the cause of fat displacement and contributes to facial sagging, droopiness and an aged look. With good understanding of muscle balance in the face and by relaxing certain muscle groups, we can help reverse some of the age-related changes.

Fat Loss and Redistribution:

The superficial fat compartments lose volume over time and fat tissue redistribute according to effect of gravity. As discussed in our foundation course, this layer is firmly attached to the skin but loosely attached to the SMAS layer, resulting in pseudoptosis of the overlying skin as we age.

The deep fat pads are prone to the effects of aging too. In the suborbital area, as the orbicularis oculi muscle becomes weaker and combined with bone changes, the SOOF protrudes through the muscle fibres, forming eye bags. 

Skin changes:

As we start to age, the number and activity of fibroblasts will decrease. The resulting reduction in hyaluronic acid, elastin and collagen lead to thinner, drier and less elastic skin. Furthermore, remaining collagen fibres in the skin are poorly organised in a random manner, compared to younger skin.