With progressive ageing, changes occur in the bone, muscle and the fat of the face. The bony orbit or socket of the eye, the temples and the cheekbones in particular experience loss of bone-density, becoming thinner in the process. In the cheeks, this results in a significant loss of projection with ageing. In the lower face, the mandible tends to expand throughout ageing, both in width and height.
There is not a great deal of research on the changes within the muscle structure itself during ageing, however, it is widely accepted that repetitive muscle movements contribute to the appearance of both fine lines and deep wrinkles. This affects the muscles of the forehead (frontalis, and corrugators muscles) and the corners of the eyes (orbicularis oculi) resulting in undesirable frown lines and crow’s feet.
Changes in the soft tissues of the face are key contributors to the appearance of facial ageing. In the upper third of the face, changes in skin elasticity and repetitive movements of the muscles around the eyes resulting in drooping brows, as well as folding of the skin of the upper eyelid, resulting in a tired appearance. In the middle third of the face, fat stores in the cheeks begin to fade and ligaments supporting the fat pads of the cheek weaken. This reduction in fat and shifting of the fat pad makes cheeks appear hollow.
Other changes in the midface include the appearance and deepening of nasolabial folds, especially in individuals who are particularly expressive. In the lower third of the face, vertical lines often appear above the border of the lips due to the thinning of skin in this area. Jowls appearing on the lower cheek and jaw. It is thought that this loose skin of the cheeks and jaw are due to loss and/or shifting of fat reserves, gravity, and changes to the jaw bone. In addition, increases in upper lip length and thinning of the lips have also been noted with progressive ageing. Repetitive pursing movements result in Smoker’s lines over time. Interestingly, even non-smokers will develop Smoker’s lines, although generally, they are not as severe.
The net effect of these processes is thinning of the bones and a skeletonized appearance, with fat pad and muscle atrophy as well as reduced skin elasticity and thickness. This results in a sunken appearance, sagging of the face including jowls, a narrower upper face and wider lower face and wrinkles. This contrast, to the classic youthful face that has balanced or ‘ideal’ skeletal proportions within a think, soft supple tissue envelope resulting in a relatively wide upper face and narrow lower face.