Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation

Abstract

In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping have constituted the cornerstone of most facial rejuvenation procedures. Changes in the facial skeleton that occur with aging and their impact on facial appearance have not been well appreciated. Accordingly, failure to address changes in the skeletal foundation of the face may limit the potential benefit of any rejuvenation procedure. Correction of the skeletal framework is increasingly viewed as the new frontier in facial rejuvenation. It currently is clear that certain areas of the facial skeleton undergo resorption with aging. Areas with a strong predisposition to resorption include the midface skeleton, particularly the maxilla including the pyriform region of the nose, the superomedial and inferolateral aspects of the orbital rim, and the prejowl area of the mandible. These areas resorb in a specific and predictable manner with aging. The resultant deficiencies of the skeletal foundation contribute to the stigmata of the aging face. In patients with a congenitally weak skeletal structure, the skeleton may be the primary cause for the manifestations of premature aging. These areas should be specifically examined in patients undergoing facial rejuvenation and addressed to obtain superior aesthetic results.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Electronic supplementary materialThe online version of this article (doi:10.1007/s00266-012-9904-3) contains supplementary material, which is available to authorized users.

Características orofaciais de idosos funcionalmente independentes

“…Several studies associate these changes in appearance and mobility of the face with age progression, especially compared with young individuals (22)(23)(24)(25) . However, this progressive relationship was not found in the present article, probably because the sample is composed exclusively of patients aged 60 years or older, where structural changes are believed to be already in place and tend to advance slowly.…”

“…Ideally, it would be interesting to make linear observations of the same individuals longitudinally. However, it should be admitted that such studies are difficult to perform and, based on the emerging need for relevant data, recent research is using association of several methods, which has produced realistic and reliable results (23,27) .…”

“…Thinning of the epidermis and dermis, as well as fragmented collagen fibers, are known structural modifications in aged skin. Furthermore, skeletal changes occur as age progresses; some areas continue to grow, while others present bone resorption, promoting new angles between the facial bones (22,23) . The transformation of muscular insertions associated with reduction in elasticity of the dermis, reduction of the mobility and tension of facial muscles, and increase of the subcutaneous adipose layer, make up facial flaccidity, a characteristic of aging (24)(25)(26)(27) .…”

Nasal Aging and Rejuvenation

“…These events, although nonexclusive, are more prominent in males, which manifest thicker and heavier tissues [5][6]. The bony aspect of the nose experiments enlargement of the piriform aperture and reabsorption of the anterior nasal spine points, where the whole structure of the nose is anchored [7][8][9][10].…”

Textbook of Plastic and Reconstructive Surgery

“…The midface, including the anterior cheek and lower eyelids. The midface is a triangular area below the eyelid bounded medially by the nasofacial angle, inferiorly by the nasolabial fold and corner of the mouth, and superiorly by the lower eyelid and tear trough and the lateral canthus at the superolateral aspect (Mendelson and Wong, 2012). Key elements of midfacial ageing are gradual ptosis of the cheek skin below the infraorbital rim, creating infraorbital hollowness, descent of the malar fat pad with loss of malar prominence, deepening of the tear trough and associated exaggeration of the nasolabial fold (Owsley, 1993;Stuzin et al, 1995;Hester, 2001;Paul et al, 2006;Saltz and Ohana, 2012).…”