Download PDF
Facial Plast Surg 2010; 26(5): 350-355
DOI: 10.1055/s-0030-1265024
© Thieme Medical Publishers

Overview of Current Thoughts on Facial Volume and Aging

David M. Kahn1 , Robert B. Shaw2
  • 1Division of Plastic and Reconstructive Surgery, Department of General Surgery, Stanford University Medical Center, Stanford, California
  • 2Division of Plastic and Reconstructive Surgery, Department of General Surgery, University of Rochester Medical Center, Rochester, New York
Further Information

Publication History

Publication Date:
17 September 2010 (online)

    Permissions and Reprints

ABSTRACT

Facial aging is a dynamic process involving the aging of soft tissue and bony structures. Much is known in regards to how the face loses volume as the soft tissue structures age. Epidermal thinning and the decrease in collagen cause skin to lose its elasticity. Loss of fat, coupled with gravity and muscle pull, leads to wrinkling and the formation of dynamic lines.

The aging process has also been shown to affect the facial bones. Multiple studies suggest that the bony aging of the orbit and midface is a process primarily of contraction and morphologic change. This loss of bony volume and projection may contribute to the aged appearance. In this review, we will demonstrate how specific soft tissue and bony aspects of the face change with age in both genders and what impact these structural changes may have on overall facial aesthetics.

KEYWORDS

Facial aging - facial volume - facial bones - facial fat

REFERENCES

  • 1 Lambros V. Observations on periorbital and midface aging.  Plast Reconstr Surg. 2007;  120 1367-1376 discussion 1377
    CrossrefPubMedGoogle Scholar
  • 2 Mendelson B C, Jacobson S R. Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments.  Clin Plast Surg. 2008;  35 395-404 discussion 393
    CrossrefPubMedGoogle Scholar
  • 3 Bosset S, Barré P, Chalon A et al.. Skin ageing: clinical and histopathologic study of permanent and reducible wrinkles.  Eur J Dermatol. 2002;  12 247-252
    PubMedGoogle Scholar
  • 4 Fenske N A, Lober C W. Structural and functional changes of normal aging skin.  J Am Acad Dermatol. 1986;  15(4 Pt 1) 571-585
    CrossrefPubMedGoogle Scholar
  • 5 El-Domyati M, Attia S, Saleh F et al.. Intrinsic aging vs. photoaging: a comparative histopathological, immunohistochemical, and ultrastructural study of skin.  Exp Dermatol. 2002;  11 398-405
    CrossrefPubMedGoogle Scholar
  • 6 Mendelson B C, Freeman M E, Wu W, Huggins R J. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold.  Aesthetic Plast Surg. 2008;  32 185-195
    Google Scholar
  • 7 Little J W. Applications of the classic dermal fat graft in primary and secondary facial rejuvenation.  Plast Reconstr Surg. 2002;  109 788-804
    Google Scholar
  • 8 Coleman S R. Structural fat grafts: the ideal filler?.  Clin Plast Surg. 2001;  28 111-119
    CrossrefPubMedGoogle Scholar
  • 9 Stuzin J M, Baker T J, Baker T M. Refinements in face lifting: enhanced facial contour using vicryl mesh incorporated into SMAS fixation.  Plast Reconstr Surg. 2000;  105 290-301
    CrossrefPubMedGoogle Scholar
  • 10 Rohrich R J, Pessa J E. The anatomy and clinical implications of perioral submuscular fat.  Plast Reconstr Surg. 2009;  124 266-271
    CrossrefPubMedGoogle Scholar
  • 11 Rohrich R J, Arbique G M, Wong C, Brown S, Pessa J E. The anatomy of suborbicularis fat: implications for periorbital rejuvenation.  Plast Reconstr Surg. 2009;  124 946-951
    CrossrefPubMedGoogle Scholar
  • 12 Rohrich R J, Pessa J E. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments.  Plast Reconstr Surg. 2008;  121 1804-1809
    CrossrefPubMedGoogle Scholar
  • 13 Lambros V. Models of facial aging and implications for treatment.  Clin Plast Surg. 2008;  35 319-327; discussion 317
    CrossrefPubMedGoogle Scholar
  • 14 Jones D H. Semipermanent and permanent injectable fillers.  Dermatol Clin. 2009;  27 433-444, vi
    CrossrefPubMedGoogle Scholar
  • 15 Bucky L P, Kanchwala S K. The role of autologous fat and alternative fillers in the aging face.  Plast Reconstr Surg. 2007;  120(6, Suppl) 89S-97S
    CrossrefPubMedGoogle Scholar
  • 16 Behrents R G. Growth in the Aging Craniofacial Skeleton (Monograph 17, Craniofacial Growth Series). Ann Arbor, MI; University of Michigan Center for Human Growth and Development 1985
    PubMedGoogle Scholar
  • 17 Bartlett S P, Grossman R, Whitaker L A. Age-related changes of the craniofacial skeleton: an anthropometric and histologic analysis.  Plast Reconstr Surg. 1992;  90 592-600
    CrossrefPubMedGoogle Scholar
  • 18 Pessa J E, Slice D E, Hanz K R, Broadbent Jr T H, Rohrich R J. Aging and the shape of the mandible.  Plast Reconstr Surg. 2008;  121 196-200
    CrossrefPubMedGoogle Scholar
  • 19 Pecora N G, Baccetti T, McNamara Jr J A. The aging craniofacial complex: a longitudinal cephalometric study from late adolescence to late adulthood.  Am J Orthod Dentofacial Orthop. 2008;  134 496-505
    CrossrefPubMedGoogle Scholar
  • 20 Pessa J E, Zadoo V P, Mutimer K L 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;  102 205-212
    Google Scholar
  • 21 Pessa J E. 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;  106 479-488; discussion 489–490
    CrossrefPubMedGoogle Scholar
  • 22 Pessa J E, Desvigne L D, Lambros V S, Nimerick J, Sugunan B, Zadoo V P. Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids.  Aesthetic Plast Surg. 1999;  23 337-342
    CrossrefPubMedGoogle Scholar
  • 23 Pessa J E, Zadoo V P, 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;  103 635-644
    CrossrefPubMedGoogle Scholar
  • 24 Pessa J E. 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;  106 479-488; discussion 489–490
    CrossrefPubMedGoogle Scholar
  • 25 Pessa J E, Chen Y. Curve analysis of the aging orbital aperture.  Plast Reconstr Surg. 2002;  109 751-755; discussion 756–760
    CrossrefPubMedGoogle Scholar
  • 26 Shaw Jr R B, Katzel E B, Koltz P F, Kahn D M, Girotto J A, Langstein H N. Aging of the mandible and its aesthetic implications.  Plast Reconstr Surg. 2010;  125 332-342
    CrossrefPubMedGoogle Scholar
  • 27 Kahn D M, Shaw Jr R B. Aging of the bony orbit: A three dimensional CT study.  Aesthet Surg J. 2008;  28 258-264
    CrossrefPubMedGoogle Scholar
  • 28 Shaw Jr R B, Kahn D M. Aging of the mid-face bony elements: a three dimensional CT study.  Plast Reconstr Surg. 2007;  119 675-681
    Google Scholar
  • 29 Stuzin J M. Restoring facial shape in face lifting: the role of skeletal support in facial analysis and midface soft-tissue repositioning.  Plast Reconstr Surg. 2007;  119 362-376; discussion 377–378
    CrossrefPubMedGoogle Scholar
  • 30 Fattahi T. The prejowl sulcus: an important consideration in lower face rejuvenation.  J Oral Maxillofac Surg. 2008;  66 355-358
    CrossrefPubMedGoogle Scholar
  • 31 Matros E, Momoh A, Yaremchuk M J. The aging midfacial skeleton: implications for rejuvenation and reconstruction using implants.  Facial Plast Surg. 2009;  25 252-259
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Flowers R S. Augmentation maxilloplasty. In: Terino EO, Flowers RS The Art of Alloplastic Facial Contouring. St. Louis, MO; Mosby 2000: 129-150
    PubMedGoogle Scholar
  • 33 Yaremchuk M J. Facial skeletal reconstruction using porous polyethylene implants.  Plast Reconstr Surg. 2003;  111 1818-1827
    CrossrefPubMedGoogle Scholar

David M KahnM.D. 

Division of Plastic and Reconstructive Surgery, Department of General Surgery

Stanford University Medical Center, 770 Welch Road, Palo Alto, CA 94304

Email: david.kahn@stanford.edu

      >