Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Aesthetic
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

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 IV This 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hellman, M.: Changes in the human face brought about by development. Int J Orthod 13, 475 (1927)

    Google Scholar 

  2. Todd, T.W.: Thickness of the white male cranium. Anat Rec 27, 245 (1924)

    Google Scholar 

  3. Lasker, G.W.: The age factor in bodily measurements of adult male and female Mexicans. Hum Biol 25, 50 (1953)

    CAS  PubMed  Google Scholar 

  4. Garn, S.M., Rohmann, C.G., Wagner, B., Ascoli, W.: Continuing bone growth during adult life: a general phenomenon. Am J Phys Anthropol 26, 313 (1967)

    CAS  PubMed  Google Scholar 

  5. Behrents, R.G.: Growth in the aging craniofacial skeleton. University of Michigan Center for Human Growth and Development, Ann Arbor (1985)

    Google Scholar 

  6. Bartlett, S.P., Grossman, R., Whitaker, L.A.: Age-related changes of the craniofacial skeleton: an anthropometric and histologic analysis. Plast Reconstr Surg 90, 592–600 (1992)

    CAS  PubMed  Google Scholar 

  7. Cawood, J.I., Howell, R.A.: A classification of the edentulous jaws. Int J Oral Maxillofac Surg 17, 232 (1988)

    CAS  PubMed  Google Scholar 

  8. Kahn, D.M., Shaw Jr., R.B.: Aging of the bony orbit: a threedimensional computed tomographic study. Aesthet Surg J 28, 258–264 (2008)

    PubMed  Google Scholar 

  9. Pessa, J.E., Chen, Y.: Curve analysis of the aging orbital aperture. Plast Reconstr Surg 109, 751–755 (2002)

    PubMed  Google Scholar 

  10. Pessa JE (2000) 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 106:479–488 (discussion 489–490)

  11. Shaw Jr., R.B., Kahn, D.M.: Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 119, 675–681 (2007)

    CAS  PubMed  Google Scholar 

  12. Mendelson, B.C., Hartley, W., Scott, M., McNab, A., Granzow, J.W.: Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthet Plast Surg 31, 419–423 (2007)

    Google Scholar 

  13. Pessa, J.E., Zadoo, V.P., Yuan, C., Ayedelotte, J.D., Cuellar, F.J., Cochran, C.S., Mutimer, K.L., Garza, J.R.: Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg 103, 635–644 (1999)

    CAS  PubMed  Google Scholar 

  14. Pessa, J.E., Zadoo, V.P., Mutimer, K.L., Haffner, C., Yuan, C., DeWitt, A.I., Garza, J.R.: 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 102, 205–212 (1998)

    CAS  PubMed  Google Scholar 

  15. 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 121, 196–200 (2008)

    CAS  PubMed  Google Scholar 

  16. Enlow, D.H.: A morphogenetic analysis of facial growth. Am J Phys Anthropol 52, 283 (1966)

    CAS  Google Scholar 

  17. Enlow, D.H.: The Human Face. Harper and Row, New York (1968)

    Google Scholar 

  18. Levine, R.A., Garza, J.R., Wang, P.T., Hurst, C.L., Dev, V.R.: Adult facial growth: applications to aesthetic surgery. Aesthet Plast Surg 27, 265 (2003)

    Google Scholar 

  19. Levine, R.A.: Aging of the midface bony elements. Plast Reconstr Surg 121, 698–699 (2008)

    CAS  PubMed  Google Scholar 

  20. Rosas, A., Bastir, M.: Thin plate spline analysis of allometry and sexual dimorphism in the human craniofacial complex. Am J Phys Anthropol 117, 236 (2002)

    PubMed  Google Scholar 

  21. Jacobson, A.L.: Radiographic cephalometry. Quintessence Publishing Co, Chicago (1995)

    Google Scholar 

  22. Ferrario, V.F., Sforza, C., Poggio, C.E., et al.: Effects of growth and development on cephalometrics shapes in orthodontic patients: a Fourier analysis. Eur J Orthod 19, 669 (1997)

    CAS  PubMed  Google Scholar 

  23. Bolin, A.: Proximal alveolar bone loss in a longitudinal radiographic investigation. Swed Dent J Suppl 35, 1 (1986)

    CAS  PubMed  Google Scholar 

  24. Flowers, R.S.: Periorbital aesthetic surgery for men: eyelids and related structures. Clin Plast Surg 18, 689–729 (1991)

    CAS  PubMed  Google Scholar 

  25. Rohrich, R.J., Hollier Jr., L.H., Janis, J.E., Kim, J.: Rhinoplasty with advancing age. Plast Reconstr Surg 114, 1936–1944 (2004)

    PubMed  Google Scholar 

  26. Pessa, J.E., Peterson, M.L., Thompson, J.W., Cohran, C.S., Garza, J.R.: Pyriform augmentation as an ancillary procedure in facial rejuvenation surgery. Plast Reconstr Surg 103, 683–686 (1999)

    CAS  PubMed  Google Scholar 

  27. Barton, F.E., Gyimesi, I.: Anatomy of the nasolabial fold. Plast Reconstr Surg 100, 1276–1280 (1997)

    PubMed  Google Scholar 

  28. Edelstein, D.R.: Aging of the normal adult nose. Laryngoscope 106, 1–25 (1996)

    CAS  PubMed  Google Scholar 

  29. 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 Dentofac Orthop 134, 496–505 (2006)

    Google Scholar 

  30. 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 125, 332–342 (2010)

    CAS  PubMed  Google Scholar 

  31. Romo, T., Yalamanchili, H., Sclafani, A.P.: Chin and prejowl augmentation in the management of the aging jawline. Facial Plast Surg 21, 38–46 (2005)

    CAS  PubMed  Google Scholar 

  32. Rosen, H.M.: Treatment planning: aesthetic goals. In: Rosen, H.M. (ed.) Aesthetic perspectives in jaw surgery, pp. 3–23. Springer, New York (1999)

    Google Scholar 

  33. Terino, E.O., Edwards, M.C.: Alloplastic contouring for suborbital, maxillary, zygomatic deficiencies. Facial Plast Surg Clin North Am 16, 33–67 (2008)

    PubMed  Google Scholar 

  34. Terino, E.O., Edward, M.: The magic of midface threedimensional contour alterations combining alloplastic and soft tissue suspension technologies. Clin Plast Surg 35, 419–450 (2008)

    PubMed  Google Scholar 

  35. Whitaker, L.A., Bartlett, S.P.: Skeletal alterations as a basis for facial rejuvenation. Clin Plast Surg 18, 197–203 (1991)

    CAS  PubMed  Google Scholar 

  36. Le Louarn, C., Buthiau, D., Buis, J.: Structural aging: the facial recurve concept. Aesthet Plast Surg 31, 213–218 (2007)

    Google Scholar 

  37. Matros, E., Garcia, J.A., Yaremchuk, M.J.: Changes in the eyebrow position and shape with aging. Plast Reconstr Surg 124, 1296 (2009)

    CAS  Google Scholar 

  38. Hinderer, U.: Malar implants for improvement of the facial appearance. Plast Reconstr Surg 56, 157 (1975)

    CAS  PubMed  Google Scholar 

  39. Gonzalez-Ulloa, M.: Building out the malar prominences as an addition to rhytidectomy. Plast Reconstr Surg 53, 293 (1974)

    CAS  PubMed  Google Scholar 

  40. Byrd, H.S., Hobar, P.C., Shewmake, K.: Augmentation of the craniofacial skeleton with porous hydroxyapatite granules. Plast Reconstr Surg 91, 15 (1993)

    CAS  PubMed  Google Scholar 

  41. Byrd, H.S., Hobar, P.C.: Augmentation of the cheekbones with porous hydroxyapatite granules. Perspect Plast Surg 8, 98 (1994)

    Google Scholar 

  42. O'Hara, K.L., Urrego, A.F., Garri, J.I., O'Hara, C.M., Bradley, J.P., Kawamoto, H.K.: Improved malar projection with transconjunctival hydroxyapatite granules. Plast Reconstr Surg 117, 1956–1963 (2006)

    CAS  PubMed  Google Scholar 

  43. Waite, P.D., Matukas, V.J.: Zygomatic augmentation with hydroxylapatite: a preliminary report. J Oral Maxillofac Surg 44, 349 (1986)

    CAS  PubMed  Google Scholar 

  44. Moreira-Gonzalez, A., Jackson, I.T., Miyawaki, T., DiNick, V., Yavuzer, R.: Augmentation of the craniomaxillofacial region using porous hydroxyapatite granules. Plast Reconstr Surg 111, 1808 (2003)

    PubMed  Google Scholar 

  45. El Deeb, M., Tompach, P.C., Morstad, A.T.: Porous hydroxylapatite granules and blocks as alveolar ridge augmentation materials: a preliminary report. J Oral Maxillofac Surg 46, 955 (1988)

    PubMed  Google Scholar 

  46. Mendelson, B.C., Jacobson, S.R., Lavoipierre, A.M., Huggins, R.J.: The fate of porous hydroxyapatite granules used in facial skeletal augmentation. Aesthet Plast Surg 34, 455–461 (2010)

    Google Scholar 

  47. Perrett, D.I., May, K.A., Yoshikawa, S.: Facial shape and judgments of female attractiveness. Nature 368, 239–242 (1994)

    CAS  PubMed  Google Scholar 

  48. Valenzano, D.R., Mennucci, A., Tartarelli, G., Cellerino, A.: Shape analysis of female attractiveness. Vis Res 46, 1282 (2006)

    PubMed  Google Scholar 

  49. Pessa, J.E.: The effect of skeletal remodeling on the nasal profile: considerations for rhinoplasty in the older patient. Aesthet Plast Surg 23(4), 239–242 (1999)

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Centre for Facial Plastic Surgery, 109 Mathoura Road, Toorak, VIC 3142, Australia

    Bryan Mendelson

  2. W Aesthetic Plastic Surgery, Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, #08 - 42, Singapore, 329563, Singapore

    Chin-Ho Wong

Authors
  1. Bryan Mendelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chin-Ho Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bryan Mendelson.

Additional information

Open Access

This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

This article is being reprinted for ISAPS 50th Anniversary Special Issue.

This article includes a video clip available online for authorized users.

Electronic Supplementary Materials

Below is the link to the electronic supplementary material.

Supplementary file1 (mp4 2114 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mendelson, B., Wong, CH. Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesth Plast Surg 44, 1151–1158 (2020). https://doi.org/10.1007/s00266-020-01823-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-020-01823-x

Keywords

Search

Navigation