Why Your Face Ages

The face ages in response to a number of factors, which may appear to varying degrees between individuals. Sun exposure and smoking tend to accelerate the following changes:

1. Chronic ultraviolet light damage to the skin: Photoaging adds to the inevitable changes seen with intrinsic chronologic aging; indeed, cumulative sun exposure is the single largest factor involved in our clinical perception of aging skin, and it is responsible for a large portion of unwanted esthetic effects.
2. Loss of subcutaneous fat: In general, with age there is a loss of the fullness and roundness of the facial contours of youth, resulting in a flattened or sunken appearance to facial structures.
3. Changes in the intrinsic muscles of facial expression and their influence on the skin: The muscles of facial expression are unique in that they insert directly into the skin. Years of facial expressions constantly folding the skin result in the progressive development of hyperdynamic wrinkles, which initially appear only with facial movement, but may ultimately remain as wrinkles at rest. Hyperdynamic wrinkles are more prominent in areas where the underlying muscles and fascia have more direct attachments to the skin, such as in the frontal, glabellar, nasolabial, perioral, and periocular areas.
4. Gravitational changes from loss of elasticity of the tissue: With aging, the facial soft tissues lose their inherent resiliency and ability to resist stretching; inevitably, they begin to sag under the effects of gravity.
5. Remodeling of the underlying bony and cartilaginous structures: Over time, bony resorption may result in a decrease in apparent facial volume, and gravitational stretch of cartilaginous structures may result in the drooping of structures such as the nasal tip. Facial asymmetry due to underlying bony or cartilaginous structural changes is difficult to correct, and pointing out these differences at the initial consultation is important in setting realistic patient expectations.