The face changes with age, no two ways about it. Gravity, photo-damage and the passing of time affect the skin, muscles and other soft tissue of the face. Scientists are now finding that the bone structure of the face also changes as we age.

Many things about our faces change with age. The skin, muscle, fat and other soft tissue layers of our face all change as the years go by. Our facial bones and cartilage structure do, too. Okay, change happens, so what do we know about it? Do we take the time to sit down and consider how our faces will likely change as we age? A close look at photos taken when we were younger can provide clues about what is to come. If we resemble our parents, aunts, uncles, or elder siblings, we can learn even more about how we will look as we age. You can think of this as an unpleasant task, but, as with most things, forewarned is forearmed. If you care about your appearance, taking time to better understand the likely changes will help you make better decisions about facial rejuvenation. Treatment plans for each individual should take all these potential changes into account.

The foundation of traditional rejuvenation procedures is the repositioning and redraping of the facial skin—the facelift. Other cosmetic interventions, such as treatments with injectables, and skin smoothing and tightening techniques, also focus on the soft tissues of the face. The new frontier in the rejuvenation process focuses on correcting the face’s skeletal framework.

Let’s look at the many ways facial structures change over time and how facial rejuvenation efforts can benefit from this knowledge. Understanding the many changes that our faces might undergo, let us stop a piecemeal approach to facial rejuvenation—a tuck here, a nip there and an injection somewhere else—and consider a more measured and planned approach.

Everyone ages differently, of course, and the predictable changes will occur in different degrees and at different times in different people. Men and women age differently as well. This article considers, in general terms, the common facial changes that come about with ageing.

How ageing changes facial skin

The skin is the body’s biggest organ. It envelopes us from head to toe and bears the wear and tear of daily life.

Skin can be broadly divided into three main layers. The epidermis or outer skin layer, contains skin cells and pigments that give colour to our skin. The dermis, the middle layer, has blood vessels, nerves, oil glands and hair follicles. The epidermis gets its nutrition from the dermis. The deeper layer of skin that lies underneath the dermis is called the subcutaneous layer. It contains sweat glands, blood vessels, some hair follicles and fatty tissue. Each layer of the skin also contains collagen and elastin fibers. While the collagen provides support, elastin fibers give strength and flexibility. Ageing affects all of these layers of our facial skin.

The epidermis thins with age, even though the number of cell layers remains the same. The numbers of melanocytes—the cells that contain pigments—diminish with age while the remaining pigment cells grow in size. These changes make the ageing skin appear thinner, paler and more translucent. Age spots— large pigmented spots also called liver spots or lentigos—may appear in areas exposed to the sun.

Ageing also affects our collagen and elastin, the connective tissue fibers in the skin, weakening the skin’s strength and elasticity. Lack of elasticity is more pronounced in areas exposed to the sun. Producing the weather-beaten, leathery appearance common to those who have spent long hours out of doors or been over-exposed to tanning rays. Although you cannot reverse the effects of ageing entirely, you can protect your skin and avoid further skin damage.

Ageing also makes the blood vessels of the skin more fragile, leading to bruising, bleeding under the skin and cherry angiomas, bright cherry red non-cancerous growths made up of blood vessels. These may vary in size and texture, from as large as a quarter of an inch to as small as a pinhead. They can appear smooth or stick out of the skin.

Our sebaceous glands produce oil to keep our skin lubricated. They produce less and less oil with age. The oil produced in women’s skins diminishes after menopause; men experience only a minimal reduction, typically after the age of 80. Reduced oil makes the skin dry and may cause itchiness.

The subcutaneous fat layer also thins with age, reducing the skin’s normal insulation and padding, increasing risk of injury. It also makes it harder to maintain body temperature, making us more vulnerable to hypothermia during cold spells. One reason people lose their youthful rounded looks and appear gaunt as they age is due to the thinning of the fat layer on the face, especially the cheeks, chin, brows and around the eyes. Some people develop extra fat deposits under the chin and under the eyes. Loss of fat in some areas and fat accumulation in others can make the face appear unbalanced.

Skin typically becomes darker, rougher and less flexible over time. Our faces develop fine lines, furrows, wrinkles, skin folds and pouches. Blemishes and discolorations begin to appear and become more pronounced with age. Some people have oily skin while others have dry skin. These differences also play a role in how our skins age. They also matter in how facial rejuvenation techniques work, and their results.

But ageing does not tell the entire story of the many changes that occur in our face. Our skin and other changes also have to do with heredity, environmental influences, nutrition and other factors.

The greatest single factor that affects the skin is sun exposure. The level of photo-damage varies in the different parts of the body. The skin on our faces and necks suffer the worst damage. Although natural pigmentation offers some level of protection, blue-eyed, fair skinned people suffer the highest levels of sun damage.

How ageing changes facial muscle and other soft tissue layers of the face

Facial muscles under voluntary control are called the skeletal or lean muscles and are attached to our skull. These are what allow us to express emotion by scowling, smiling, frowning or laughing. As we age, these facial skeletal muscles also begin to deteriorate. They lose their mass (or volume), strength and elasticity. Although the biggest changes appear while people are in their 40s or 50s, these changes typically begin in the mid thirties and continue into old age.

Studies have shown that total muscle mass in the body decreases by nearly 50 percent between the ages 20 and 90. People are, on average, likely to lose about 30 percent of their strength between the ages 50 and 70; followed by another 30 percent by the time they reach 80. Past the age of 40,  we lose approximately one percent of our muscle mass each year. The relationship between loss of strength and loss of muscle mass in mammals is not well understood but is unlikely to be simple and straightforward.

Laxness of facial muscles and loss of muscle mass are just two factors that lead to facial sagging. Skin elasticity and fat mass also play a role. Japanese researchers from the Shiseido Life Science Research Center who studied sagging of the cheeks found that the relationships between these factors vary in the different parts of the cheek. Their conclusion: “Sagging may be associated with the reduction of skin elasticity and mimetic muscle function and increase of fat mass, but the relationships are different in different areas of the cheek.” [1]

And that is just the cheeks! There are about 43 muscles in the human face, including many of the muscles we use to express emotion in the mouth, eyes, nose and forehead. Many of the facial muscles are controlled by the facial nerve, which branches out into various parts of the face near your ear. Because nerves have a lot to do with muscle functioning, weaknesses and deterioration of our nerves also factor into how muscles work.

In the upper third of the face, muscle paralysis and weakness leads to droopiness around the brow. The same thing occurs in the upper eyelids. Skin on the forehead develops horizontal lines, and glabellar lines develop between the eyebrows. Although it’s easy and tempting to explain these changes by referring to just skin changes—as it has been for so many years—research shows that skin laxity as well as changes in muscle mass and strength, and changes that occur in the facial bone structure should be factored in. Many of these changes are not yet fully understood.

[1] Ezure T, Hosoi J, Amano S, Tsuchiya T. Sagging of the cheek is related to skin elasticity, fat mass and mimetic muscle function. Skin Res Technol. 2009 Aug;15(3):299-305. doi: 10.1111/j.1600-0846.2009.00364.x. Accessed on 28 April 2013 at: http://www.ncbi.nlm.nih.gov/pubmed/19624426

How ageing changes the skeletal structure of the face

The human face is formed by many bones that are fused together. These bones all grow and develop at different rates. This ability of selective growth in facial bones is what allows the tiny skull of an infant to grow and assume the distinctly different shape and much larger size of an adult skull.

While most of us find it difficult to distinguish little boys from girls during infancy (if not for their gender obvious clothing), it is easy, most of the time, to tell adult males and females apart. During the maturing process, beginning with adolescence, many males develop a brow ridge above their eyes. Their jaw bones grow larger than females’. The rims of their eyeholes also assume a different shape with age. These facial bone changes occur at different rates in males and females. [1]

Changes to the facial bone structure do not end once the facial skeleton has reached its adult dimensions. Our facial bones continue to change over time, with some expanding, and others slowly breaking down or melting away in a process called retrusion. Facial height continues to grow until factors like tooth loss have the opposite effect. The skeletal structure of the face—front to back, as well as the facial width—also continues expanding throughout life. [2] Bone retrusion occurs in the mid face area, including the cheek bones, even in people who retain all their teeth, although not at a uniform rate. Our understanding of what exact changes occur in the facial bones is expanding every year. This broadens the scope for aesthetic rejuvenation of the face. In fact, correction of the skeletal framework of the face is considered a new frontier in facial rejuvenation.

[1] Bryan Mendelson and Chin-Ho Wong. Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesthetic Plast Surg. 2012 August; 36(4): 753–760. Published online 2012 May 12. doi:  10.1007/s00266-012-9904-3. Accessed online on 26 April 2013 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404279/

[2] Bryan Mendelson and Chin-Ho Wong. Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesthetic Plast Surg. 2012 August; 36(4): 753–760. Published online 2012 May 12. doi:  10.1007/s00266-012-9904-3. Accessed online on 26 April 2013 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404279/


An appreciation of the many potential changes in our faces due to ageing should pave the way for better planned and timed facial rejuvenation practices. This appreciation and understanding is reflected in procedures like the deep plane facelift, which rather than merely pulling skin and muscle, focus on the deeper tissue layers of the face to produce longer lasting results. In the same way, non-surgical rejuvenation treatments too will have to evolve over time to help us put our potential best faces forward.

In seeking these services, we should strive to find a service provider who understands all of the potential changes that are likely to occur in our faces as we age. Once there is a broader understanding we’ll begin to take a more conservative approach to facial rejuvenation. A measured, planned and timely approach will help us look our best regardless of age and will also lead to age appropriate facial rejuvenation treatments.

You can read more about age appropriate facial rejuvenation methods that experts recommend in our article, How Young is Too Young to Start Anti-Ageing Treatments?

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