• Facial aging process begins with the surface and subsurface structural changes in multiple facial tissue layers, including skin, fat, muscle and bone.
  • Facial tissue layers age interdependently, contributing to the overall facial appearance

Facial aging is due to changes in several types of tissue, including skin, fat, muscle, and bone.


With age, skin undergoes several changes, Changes include:

  • Thinner skin
  • Drier skin
  • Less elastic skin
  • Skin more likely to wrinkle or sag
  • Reduction in collagen


Collagen loss is a key factor in the aging process. As skin ages, the middle layer of skin (dermis) thins due to collagen loss. This reduces the skin’s ability to retain elasticity (from elastin) and moisture (from hyaluronic acid). Due to this loss of elastin and hyaluronic acid, the skin becomes:

  • Dryer
  • Less supple
  • Less elastic
  • Thinner (volume loss)


A youthful look depends on having the right amount of facial fat in the right places. Redistribution, accumulation, and atrophy of fat lead to facial volume loss

  • Some areas lose fat. Examples are the forehead and cheeks.
  • Other areas gain fat. Examples are the mouth and jaw
  • Modification of the fat pads leads to contour deficiencies

In addition, the areas of the fat tend to become farther apart. Instead of a smooth, almost continuous layer, the fat pads appear as separate structures.


There is a significant loss of facial bone and age. Aging of the craniofacial skeleton may be due to changes in the relative dynamics of bone expansion and bone resorption leads to biometric volume loss. Without the structural support of bone, there are noticeable changes in the other layers of overlying soft tissue and skin. Signs of Facial Aging

  • Greater visibility of bony landmarks, lines and wrinkles
  • Prominence of transverse forehead link
  • Nasolabial folds become more prominent
  • Hollowing of the mid-face (loose skin)
  • Changes in the area around the mouth (vertical wrinkles, lip thinning and flattening)
  • Development of prejowl depression (marionette lines)

Facial Mapping

With aging, the balance, proportions and symmetry of the face change. For example:

  • The lower face widens as the jowls form
  • The lower face shortens as bone is remodeled in the maxilla and mandible
  • The young face shows 1/3:2/3 ratio of upper lip to nose and lower lip to chin. With age, this ration approaches 1:1

Each of the facial sections show different changes with age are unique to each patient The goal is to achieve:

  • Symmetry on both sides of the face
  • Smooth convex contours
  • Homogeneous skin tone and texture

The transition between the anatomical regions of the face should be subtle and harmonious.

Procedure Options

Facial rejuvenation treatments can be classified in three categories:

  • Resurfacing Options – Resurfacing techniques are used to modify the surface of the skin. They correct the effects of photoaging, including fine lines, irregular pigmentation and blemishes. Common resurfacing techniques include:
    • Chemical Peels
    • Microdermabrasion
    • Laser Resurfacing
  • Injectables – Injectables include a broad range of substances which are administered by injection. Their main usage is for the treatment of lines, wrinkles and folds, as well as hollowing and volume loss. Three of the most common types include:
    • Neurotoxins
    • Traditional fillers
    • Collagen stimulators
  • Surgery – Surgery includes a wide range of procedures from lifts to liposuction to fat transfer. The treatments address a range of desired outcomes. Three of the most popular surgeries are:
    • Liposuction
    • Facelift
    • Fat Transfer


Three of the most common injectables are described below. Selection and results depend on age, category, and on the substance being injected.

  • Neurotoxins – Botulinum toxin is used to weaken muscles and minimize dynamic lines. It is injected directly into the muscle. Only lines caused by muscle contractions will be affected by botulinum toxin injections. The most common locations for treatment are in the upper third of the face – on the frown line, crows’ feet, and on the forehead lines.
  • Traditional Fillers – These are soft substances, liquids or gels, which can be injected into the skin to improve the appearance of fine lines and wrinkles, plump lips, fill out cheek hollows, and repair other facial imperfections. They work by filling out the space below the wrinkles, replacing lost fat. They can be injected into the dermis or subcutaneous layer if the skin, depending on the filer and treatment goal
  • Collagen Stimulators – As you age it is important to replace the collagen your body loses. Collagen stimulators are injected into the dermis or subcutaneous layer, filling the spaces where collagen has been lost. The newly-produced collagen provides provides a structural framework to hold hyaluronic acid and elastin and helps restore the dermis. Hyaluronic acid attracts water molecules to the dermis and restores skin moisture. Elastin provides elasticity and helps the skin stretch.