Facial Plast Surg 2015; 31(01): 03-09
DOI: 10.1055/s-0035-1544252
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Structural and Volumetric Changes in the Aging Face

David J. Gerth
1   Division of Plastic, Aesthetic, and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
12 March 2015 (online)

Abstract

Traditional views on facial aging and associated therapies focused on soft tissue descent and skin texture changes. Recently, revolumization for age-related lipoatrophy has become increasingly popular. Researchers are now reporting objective studies examining processes of structural and volumetric changes with age in increasing frequency as well. To better understand and treat facial aging, the surgeon should review all available data. Presented here are current evidence-based studies regarding age-related changes in the facial skeleton and soft tissue envelope. By reviewing these changes by each anatomic subsite, the surgeon will be better equipped to develop an appropriate treatment plan, individualized for each patient.

 
  • References

  • 1 Gonzalez-Ulloa M, Flores ES. Senility of the face–basic study to understand its causes and effects. Plast Reconstr Surg 1965; 36: 239-246
  • 2 Goldberg RA. The three periorbital hollows: a paradigm for periorbital rejuvenation. Plast Reconstr Surg 2005; 116 (6) 1796-1804
  • 3 Lambros VS. Discussion of The midface sling: a new technique to rejuvenate the midface by Yousif NJ, Matloub H, Adam N, Summers AN. Plast Reconstr Surg 2002; 110 (6) 4
  • 4 Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007; 120 (5) 1367-1376 , discussion 1377
  • 5 Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J 2006; 26 (1S): S4-S9
  • 6 Little JW. Three-dimensional rejuvenation of the midface: volumetric resculpture by malar imbrication. Plast Reconstr Surg 2000; 105 (1) 267-285 , discussion 286–289
  • 7 Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg 2000; 26 (12) 1107-1112
  • 8 Lam SM. A new paradigm for the aging face. Facial Plast Surg Clin North Am 2010; 18 (1) 1-6
  • 9 Lam SM, Glasgold MJ, Glasgold RA. Complementary Fat Grafting. Philadelphia, PA: Lippincott Williams & Wilkins; 2006
  • 10 Hellman M. Changes in the human face brought about by development. Int J Orthod 1927; 13: 475-516
  • 11 Behrents RG. The biological basis for understanding craniofacial growth during adulthood. Prog Clin Biol Res 1985; 187: 307-319
  • 12 Enlow DH. A morphogenetic analysis of facial growth. Am J Orthod 1966; 52 (4) 283-299
  • 13 Moss ML. A theoretical analysis of the functional matrix. Acta Biotheor 1968; 18 (1) 195-202
  • 14 Moss ML. The pathogenesis of premature cranial synostosis in man. Acta Anat (Basel) 1959; 37: 351-370
  • 15 Crikelair GF, Moss ML, Khuri A. Facial hemiatrophy. Plast Reconstr Surg Transplant Bull 1962; 29: 5-13
  • 16 Moss ML. The functional matrix hypothesis revisited. 1. The role of mechanotransduction. Am J Orthod Dentofacial Orthop 1997; 112 (1) 8-11
  • 17 Staley RN, Bishara SE, Hanson JW, Nowak AJ. Craniofacial development in myotonic dystrophy. Cleft Palate Craniofac J 1992; 29 (5) 456-462
  • 18 Houston K, Buschang PH, Iannaccone ST, Seale NS. Craniofacial morphology of spinal muscular atrophy. Pediatr Res 1994; 36 (2) 265-269
  • 19 Sinsel NK, Opdebeeck H, Guelinckx PJ. The effect of unilateral partial facial paralysis and muscle ablation on craniofacial growth and development: an experimental study in the rabbit. Plast Reconstr Surg 1998; 102 (6) 1894-1912
  • 20 Matic DB, Yazdani A, Wells RG, Lee TY, Gan BS. The effects of masseter muscle paralysis on facial bone growth. J Surg Res 2007; 139 (2) 243-252
  • 21 Caplan AI. Mesenchymal stem cells. J Orthop Res 1991; 9 (5) 641-650
  • 22 Zuk PA, Zhu M, Mizuno H , et al. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 2001; 7 (2) 211-228
  • 23 Dominici M, Le Blanc K, Mueller I , et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 2006; 8 (4) 315-317
  • 24 Stolzing A, Jones E, McGonagle D, Scutt A. Age-related changes in human bone marrow-derived mesenchymal stem cells: consequences for cell therapies. Mech Ageing Dev 2008; 129 (3) 163-173
  • 25 Zhou S, Greenberger JS, Epperly MW , et al. Age-related intrinsic changes in human bone-marrow-derived mesenchymal stem cells and their differentiation to osteoblasts. Aging Cell 2008; 7 (3) 335-343
  • 26 Sowa Y, Imura T, Numajiri T, Nishino K, Fushiki S. Adipose-derived stem cells produce factors enhancing peripheral nerve regeneration: influence of age and anatomic site of origin. Stem Cells Dev 2012; 21 (11) 1852-1862
  • 27 Bustos ML, Huleihel L, Kapetanaki MG , et al. Aging mesenchymal stem cells fail to protect because of impaired migration and antiinflammatory response. Am J Respir Crit Care Med 2014; 189 (7) 787-798
  • 28 Efimenko A, Dzhoyashvili N, Kalinina N , et al. Adipose-derived mesenchymal stromal cells from aged patients with coronary artery disease keep mesenchymal stromal cell properties but exhibit characteristics of aging and have impaired angiogenic potential. Stem Cells Transl Med 2014; 3 (1) 32-41
  • 29 Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg 2012; 129 (1) 263-273
  • 30 Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 2008; 121 (5) 1804-1809
  • 31 Le Louarn C, Buthiau D, Buis J. Structural aging: the facial recurve concept. Aesthetic Plast Surg 2007; 31 (3) 213-218
  • 32 Donath AS, Glasgold RA, Glasgold MJ. Volume loss versus gravity: new concepts in facial aging. Curr Opin Otolaryngol Head Neck Surg 2007; 15 (4) 238-243
  • 33 Coleman S, Saboeiro A, Sengelmann R. A comparison of lipoatrophy and aging: volume deficits in the face. Aesthetic Plast Surg 2009; 33 (1) 14-21
  • 34 Papageorgiou KI, Mancini R, Garneau HC , et al. A three-dimensional construct of the aging eyebrow: the illusion of volume loss. Aesthet Surg J 2012; 32 (1) 46-57
  • 35 Camp MC, Wong WW, Filip Z, Carter CS, Gupta SC. A quantitative analysis of periorbital aging with three-dimensional surface imaging. J Plast Reconstr Aesthet Surg 2011; 64 (2) 148-154
  • 36 Pessa JE, Chen Y. Curve analysis of the aging orbital aperture. Plast Reconstr Surg 2002; 109 (2) 751-755 , discussion 756–760
  • 37 Shaw Jr RB, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 2007; 119 (2) 675-681 , discussion 682–683
  • 38 Kahn DM, Shaw Jr RB. Aging of the bony orbit: a three-dimensional computed tomographic study. Aesthet Surg J 2008; 28 (3) 258-264
  • 39 Weaver AA, Loftis KL, Tan JC, Duma SM, Stitzel JD. CT based three-dimensional measurement of orbit and eye anthropometry. Invest Ophthalmol Vis Sci 2010; 51 (10) 4892-4897
  • 40 Shaw Jr RB, Katzel EB, Koltz PF , et al. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr Surg 2011; 127 (1) 374-383
  • 41 Lambros V. Volumizing the brow with hyaluronic acid fillers. Aesthet Surg J 2009; 29 (3) 174-179
  • 42 Farkas LG, Eiben OG, Sivkov S, Tompson B, Katic MJ, Forrest CR. Anthropometric measurements of the facial framework in adulthood: age-related changes in eight age categories in 600 healthy white North Americans of European ancestry from 16 to 90 years of age. J Craniofac Surg 2004; 15 (2) 288-298
  • 43 Wysong A, Joseph T, Kim D, Tang JY, Gladstone HB. Quantifying soft tissue loss in facial aging: a study in women using magnetic resonance imaging. Dermatol Surg 2013; 39 (12) 1895-1902
  • 44 Wysong A, Kim D, Joseph T, MacFarlane DF, Tang JY, Gladstone HB. Quantifying soft tissue loss in the aging male face using magnetic resonance imaging. Dermatol Surg 2014; 40 (7) 786-793
  • 45 Castanares S. Blepharoplasty for herniated intraorbital fat; anatomical basis for a new approach. Plast Reconstr Surg (1946) 1951; 8 (1) 46-58
  • 46 de la Plaza R, Arroyo JM. A new technique for the treatment of palpebral bags. Plast Reconstr Surg 1988; 81 (5) 677-687
  • 47 Pessa JE, Desvigne LD, Lambros VS, Nimerick J, Sugunan B, Zadoo VP. Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids. Aesthetic Plast Surg 1999; 23 (5) 337-342
  • 48 Pessa JE. An algorithm of facial aging: verification of Lambros's theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg 2000; 106 (2) 479-488 , discussion 489–490
  • 49 Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthetic Plast Surg 2007; 31 (5) 419-423
  • 50 Chen YS, Tsai TH, Wu ML, Chang KC, Lin TW. Evaluation of age-related intraorbital fat herniation through computed tomography. Plast Reconstr Surg 2008; 122 (4) 1191-1198
  • 51 Darcy SJ, Miller TA, Goldberg RA, Villablanca JP, Demer JL, Rudkin GH. Magnetic resonance imaging characterization of orbital changes with age and associated contributions to lower eyelid prominence. Plast Reconstr Surg 2008; 122 (3) 921-929 , discussion 930–931
  • 52 Richard MJ, Morris C, Deen BF, Gray L, Woodward JA. Analysis of the anatomic changes of the aging facial skeleton using computer-assisted tomography. Ophthal Plast Reconstr Surg 2009; 25 (5) 382-386
  • 53 Lee JM, Lee H, Park M, Lee TE, Lee YH, Baek S. The volumetric change of orbital fat with age in Asians. Ann Plast Surg 2011; 66 (2) 192-195
  • 54 Okuda I, Irimoto M, Nakajima Y, Sakai S, Hirata K, Shirakabe Y. Using multidetector row computed tomography to evaluate baggy eyelid. Aesthetic Plast Surg 2012; 36 (2) 290-294
  • 55 Ahmadi H, Shams PN, Davies NP, Joshi N, Kelly MH. Age-related changes in the normal sagittal relationship between globe and orbit. J Plast Reconstr Aesthet Surg 2007; 60 (3) 246-250
  • 56 Camirand A, Doucet J, Harris J. Anatomy, pathophysiology, and prevention of senile enophthalmia and associated herniated lower eyelid fat pads. Plast Reconstr Surg 1997; 100 (6) 1535-1546
  • 57 Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg 1990; 86 (1) 53-61 , discussion 62–63
  • 58 Hamra ST. Composite rhytidectomy. Plast Reconstr Surg 1992; 90 (1) 1-13
  • 59 Gosain AK, Amarante MT, Hyde JS, Yousif NJ. A dynamic analysis of changes in the nasolabial fold using magnetic resonance imaging: implications for facial rejuvenation and facial animation surgery. Plast Reconstr Surg 1996; 98 (4) 622-636
  • 60 Gosain AK, Klein MH, Sudhakar PV, Prost RW. A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg 2005; 115 (4) 1143-1152 , discussion 1153–1155
  • 61 Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg 2008; 121 (6) 2107-2112
  • 62 Corey CL, Popelka GR, Barrera JE, Most SP. An analysis of malar fat volume in two age groups: implications for craniofacial surgery. Craniomaxillofac Trauma Reconstr 2012; 5 (4) 231-234
  • 63 Pessa JE, Zadoo VP, Yuan C , et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg 1999; 103 (2) 635-644
  • 64 Bartlett SP, Grossman R, Whitaker LA. Age-related changes of the craniofacial skeleton: an anthropometric and histologic analysis. Plast Reconstr Surg 1992; 90 (4) 592-600
  • 65 Pessa JE, Zadoo VP, Mutimer KL , et al. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg 1998; 102 (1) 205-212
  • 66 Geißler S, Textor M, Kühnisch J , et al. Functional comparison of chronological and in vitro aging: differential role of the cytoskeleton and mitochondria in mesenchymal stromal cells. PLoS ONE 2012; 7 (12) e52700
  • 67 Levine RA, Garza JR, Wang PT, Hurst CL, Dev VR. Adult facial growth: applications to aesthetic surgery. Aesthetic Plast Surg 2003; 27 (4) 265-268
  • 68 Guerrissi JO, Sanchez LI. An approach to the senile upper lip. Plast Reconstr Surg 1993; 92 (6) 1187-1191
  • 69 Hinderer UT. Aging of the upper lip: a new treatment technique. Aesthetic Plast Surg 1995; 19 (6) 519-526
  • 70 Iblher N, Kloepper J, Penna V, Bartholomae JP, Stark GB. Changes in the aging upper lip—a photomorphometric and MRI-based study (on a quest to find the right rejuvenation approach). J Plast Reconstr Aesthet Surg 2008; 61 (10) 1170-1176
  • 71 Penna V, Stark GB, Eisenhardt SU, Bannasch H, Iblher N. The aging lip: a comparative histological analysis of age-related changes in the upper lip complex. Plast Reconstr Surg 2009; 124 (2) 624-628
  • 72 Iblher N, Stark GB, Penna V. The aging perioral region — Do we really know what is happening?. J Nutr Health Aging 2012; 16 (6) 581-585
  • 73 Pecora NG, Baccetti T, McNamara Jr JA. The aging craniofacial complex: a longitudinal cephalometric study from late adolescence to late adulthood. Am J Orthod Dentofacial Orthop 2008; 134 (4) 496-505
  • 74 Sforza C, Ferrario VF. Three-dimensional analysis of facial morphology: growth, development and aging of the orolabial region. Ital J Anat Embryol 2010; 115 (1-2) 141-145
  • 75 Shaw Jr RB, Katzel EB, Koltz PF, Kahn DM, Girotto JA, Langstein HN. Aging of the mandible and its aesthetic implications. Plast Reconstr Surg 2010; 125 (1) 332-342
  • 76 Jiang X, Lim SH, Mao HQ, Chew SY. Current applications and future perspectives of artificial nerve conduits. Exp Neurol 2010; 223 (1) 86-101