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Abstract

Facial aging is a process that differs among individuals but has several common underpinnings. Age-related changes occur at the cellular and subcellular levels, resulting in modifications of all tissues, including the facial bones, connective tissue, fat compartments, skin, and skin appendages. There is an overall volume loss of the face with descent of the soft tissues, giving the face a squared shape. Different zones of the face, however, age differently. Age-related alterations can be related to both intrinsic and extrinsic factors such as sun exposure, smoking, topical medications, and scarring. In this chapter, we will review the various tissue changes that occur with aging in the face and describe the anatomic changes according to the facial subunit. In-depth knowledge and detailed understanding of the changes associated with aging are essential to the plastic surgeon and further facilitate natural-appearing and effective surgical facial rejuvenation.

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References

  1. Luebberding S, Krueger N, Kerscher M. Age-related changes in male skin: quantitative evaluation of one hundred and fifty male subjects. Skin Pharmacol Physiol. 2014;27:9–17.

    Article  CAS  PubMed  Google Scholar 

  2. Noblesse E, Nizard C, Cario-André M, Lepreux S, Pain C, Schnebert S, Taïeb A, Kurfurst R. Skin ultrastructure in senile lentigo. Skin Pharmacol Physiol. 2006;19:95–100.

    Article  CAS  PubMed  Google Scholar 

  3. Makrantonaki E, Zouboulis CC. Androgens and ageing of the skin. Curr Opin Endocrinol Diabetes Obes. 2009;16:240–5.

    Article  CAS  PubMed  Google Scholar 

  4. Zouboulis CC, Chen WC, Thornton MJ, Qin K, Rosenfield R. Sexual hormones in human skin. Horm Metab Res. 2007;39:85–95.

    Article  CAS  PubMed  Google Scholar 

  5. Jacobsen E, Billings JK, Frantz RA, Kinney CK, Stewart ME, Downing DT. Age-related changes in sebaceous wax Ester secretion rates in men and women. J Invest Dermatol. 1985;85(5):483–5.

    Article  CAS  PubMed  Google Scholar 

  6. Luebberding S, Krueger N, Kerscher M. Age-related changes in skin barrier function - quantitative evaluation of 150 female subjects. Int J Cosmet Sci. 2013;35:183–90.

    Article  CAS  PubMed  Google Scholar 

  7. Williams R, Pawlus AD, Thornton MJ. Getting under the skin of hair aging: the impact of the hair follicle environment. Exp Dermatol. 2020;29:588–97.

    Article  CAS  PubMed  Google Scholar 

  8. Bonté F, Girard D, Archambault J-C, Desmoulière A. Skin changes during ageing; 2019. p. 249–80.

    Google Scholar 

  9. Rinnerthaler M, Bischof J, Streubel MK, Trost A, Richter K. Oxidative stress in aging human skin. Biomol Ther. 2015;5:545–89.

    CAS  Google Scholar 

  10. Borges AF. Relaxed skin tension lines (RSTL) versus other skin lines. Plast Reconstr Surg. 1984;73:144–50.

    Article  CAS  PubMed  Google Scholar 

  11. Kennedy C, Bastiaens MT, Bajdik CD, Willemze R, RGJ W, Bouwes Bavinck JN, Leiden Skin Cancer Study. Effect of smoking and sun on the aging skin. J Invest Dermatol. 2003;120:548–54.

    Article  CAS  PubMed  Google Scholar 

  12. Sinha RP, Häder DP. UV-induced DNA damage and repair: a review. Photochem Photobiol Sci. 2002;1:225–36.

    Article  CAS  PubMed  Google Scholar 

  13. Morita A, Torii K, Maeda A, Yamaguchi Y. Molecular basis of tobacco smoke-induced premature skin aging. J Investig Dermatol Symp Proc. 2009;14:53–5.

    Article  CAS  PubMed  Google Scholar 

  14. Okada HC, Alleyne B, Varghai K, Kinder K, Guyuron B. Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins. Plast Reconstr Surg. 2013;132:1085–92. https://doi.org/10.1097/PRS.0b013e3182a4c20a.

  15. Koh JS, Kang H, Choi SW, Kim HO. Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas. Int J Dermatol. 2002;41:21–7.

    Article  PubMed  Google Scholar 

  16. Pessa JE. SMAS fusion zones determine the subfascial and subcutaneous anatomy of the human face: fascial spaces, fat compartments, and models of facial aging. Aesthet Surg J. 2016;36:515–26.

    Article  PubMed  Google Scholar 

  17. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119:2219–27.

    Article  CAS  PubMed  Google Scholar 

  18. Wong C-H, Mendelson BC. Facial anatomy and ageing. In: Plast Reconstr Surg. Chichester, UK: John Wiley & Sons, Ltd; 2015. p. 921–39.

    Chapter  Google Scholar 

  19. Mendelson BC, Hartley W, Scott M, McNab A, Granzow JW. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthet Plast Surg. 2007;31:419–23.

    Article  Google Scholar 

  20. Wysong A, Kim D, Joseph T, MacFarlane DF, Tang JY, Gladstone HB. Quantifying soft tissue loss in the aging male face using magnetic resonance imaging. Dermatol Surg. 2014;40:786–93.

    CAS  PubMed  Google Scholar 

  21. Rohrich RJ, Avashia YJ, Savetsky IL. Prediction of facial aging using the facial fat compartments. Plast Reconstr Surg. 2021;147:38S–42S.

    Article  CAS  PubMed  Google Scholar 

  22. Gosain AK, Klein MH, Sudhakar PV, Prost RW. A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg. 2005;115:1143–52;discussion 1153-5.

    Article  CAS  PubMed  Google Scholar 

  23. Coleman S, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26:S4–9.

    Article  CAS  PubMed  Google Scholar 

  24. Penna V, Stark GB, Iblher N. Aging changes of the male lips-a lesser evil than in females? Ann Plast Surg. 2017;78(3):334–7.

    Article  CAS  PubMed  Google Scholar 

  25. Yun S, Son D, Yeo H, Kim S, Kim J, Han K, Lee S, Lee J. Changes of eyebrow muscle activity with aging: functional analysis revealed by electromyography. Plast Reconstr Surg. 2014;133:455e–63e.

    Article  CAS  PubMed  Google Scholar 

  26. Cotofana S, Assemi-Kabir S, Mardini S, Giunta RE, Gotkin RH, Moellhoff N, Avelar LET, Mercado-Perez A, Lorenc ZP, Frank K. Understanding facial muscle aging: a surface electromyography study. Aesthet Surg J. 2021;41:NP1208–17.

    Article  PubMed  Google Scholar 

  27. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. 1989;83:11–6.

    Article  CAS  PubMed  Google Scholar 

  28. Lambros V. Facial aging: a 54-year, three-dimensional population study, vol. 145. Plast Reconstr Surg; 2020. p. 921–8.

    Google Scholar 

  29. Alghoul M, Codner MA. Retaining ligaments of the face. Aesthet Surg J. 2013;33:769–82.

    Article  PubMed  Google Scholar 

  30. Farkas JP, Pessa JE, Hubbard B, Rohrich RJ. The science and theory behind facial aging. Plast Reconstr Surg Glob Open. 2013;1:1–8.

    Article  Google Scholar 

  31. Knize DM. Anatomic concepts for brow lift procedures. Plast Reconstr Surg. 2009;124:2118–26.

    Article  CAS  PubMed  Google Scholar 

  32. Moss CJ, Mendelson BC, Taylor GI. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg. 2000;105:1475–90. discussion 1491-8

    Article  CAS  PubMed  Google Scholar 

  33. Muzaffar AR, Mendelson BC, Adams WP. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast Reconstr Surg. 2002;110:873–84; discussion 897–911.

    Article  PubMed  Google Scholar 

  34. Mendelson BC, Freeman ME, Wu W, Huggins RJ. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthet Plast Surg. 2008;32:185–95.

    Article  Google Scholar 

  35. Minelli L, Yang H-M, van der Lei B, Mendelson B. The surgical anatomy of the jowl and the mandibular ligament reassessed. Aesthet Plast Surg. 2022;47:170. https://doi.org/10.1007/s00266-022-02996-3.

    Article  Google Scholar 

  36. Cotofana S, Fratila A, Schenck T, Redka-Swoboda W, Zilinsky I, Pavicic T. The anatomy of the aging face: a review. Facial Plast Surg. 2016;32:253–60.

    Article  CAS  PubMed  Google Scholar 

  37. Cotofana S, Gotkin RH, Ascher B, et al. Calvarial volume loss and facial aging: a computed tomographic (CT)-based study. Aesthet Surg J. 2018;38:1043–51.

    Article  PubMed  Google Scholar 

  38. Richard MJ, Morris C, Deen BF, Gray L, Woodward JA. Analysis of the anatomic changes of the aging facial skeleton using computer-assisted tomography. Ophthalmic Plast Reconstr Surg. 2009;25:382–6.

    Article  PubMed  Google Scholar 

  39. Mendelson B, Wong C-H. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg. 2012;36:753–60.

    Article  Google Scholar 

  40. Keaney TC. Aging in the male face: intrinsic and extrinsic factors. Dermatol Surg. 2016;42:797–803.

    Article  CAS  PubMed  Google Scholar 

  41. Kahn DM, Shaw RB. Aging of the bony orbit: a three-dimensional computed tomographic study. Aesthet Surg J. 2008;28:258–64.

    Article  PubMed  Google Scholar 

  42. Slade GD, Akinkugbe AA, Sanders AE. Projections of U.S. Edentulism prevalence following 5 decades of decline. J Dent Res. 2014;93:959–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Sutton DN, Lewis BRK, Patel M, Cawood JI. Changes in facial form relative to progressive atrophy of the edentulous jaws. Int J Oral Maxillofac Surg. 2004;33:676–82.

    Article  CAS  PubMed  Google Scholar 

  44. de GHL T, MGR P, Neppelenbroek KH, Sforza C, de Menezes M, Oliveira TM, Soares S. Evaluation by 3D stereophotogrammetry of facial changes in edentulous patients after rehabilitation. J Appl Oral Sci. 2021;30:e20210462.

    Google Scholar 

  45. Alessandrini A, Bruni F, Piraccini BM, Starace M. Common causes of hair loss - clinical manifestations, trichoscopy and therapy. J Eur Acad Dermatol Venereol. 2021;35:629–40.

    Article  CAS  PubMed  Google Scholar 

  46. Mirmirani P. Age-related hair changes in men: mechanisms and management of alopecia and graying. Maturitas. 2015;80:58–62.

    Article  PubMed  Google Scholar 

  47. Goldstein SM, Katowitz JA. The male eyebrow: a topographic anatomic analysis. Ophthalmic Plast Reconstr Surg. 2005;21:285–91.

    Article  PubMed  Google Scholar 

  48. Knize DM. Muscles that act on glabellar skin: a closer look. Plast Reconstr Surg. 2000;105:350–61.

    Article  CAS  PubMed  Google Scholar 

  49. Cohen LM, Campbell BC, Esfandiari M, Goldberg RA, Rootman DB. Ophthalmic surgeries and systemic medical conditions associated with the development of involutional ptosis. Ophthalmic Plast Reconstr Surg. 2021;37:133–7.

    Article  PubMed  Google Scholar 

  50. van den Bosch WA, Leenders I, Mulder P. Topographic anatomy of the eyelids, and the effects of sex and age. Br J Ophthalmol. 1999;83:347–52.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Alghoul M. Blepharoplasty: anatomy, planning, techniques, and safety. Aesthet Surg J. 2019;39:10–28.

    Article  PubMed  Google Scholar 

  52. Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012;129:263–73.

    Article  CAS  PubMed  Google Scholar 

  53. Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB. The facial aging process from the “Inside Out”. Aesthet Surg J. 2021;41:1107–19.

    Article  PubMed  Google Scholar 

  54. Unadkat SN, Saleh HA. Restoring balance and symmetry to the aging nose. Facial Plast Surg. 2021;37:205–10.

    Article  CAS  PubMed  Google Scholar 

  55. Romo T, Soliemanzadeh P, Litner JA, Sclafani AP. Rhinoplasty in the aging nose. Facial Plast Surg. 2003;19:309–15.

    Article  PubMed  Google Scholar 

  56. Wang D, Xiong S, Wu Y, Zeng N. Aging of the nose: a quantitative analysis of nasal soft tissue and bone on computed tomography. Plast Reconstr Surg. 2022;150:993e–1000e.

    Article  CAS  PubMed  Google Scholar 

  57. Meijerman L, van der Lugt C, Maat GJR. Cross-sectional anthropometric study of the external ear. J Forensic Sci. 2007;52:286–93.

    Article  PubMed  Google Scholar 

  58. Sforza C, Grandi G, Binelli M, Tommasi DG, Rosati R, Ferrario VF. Age- and sex-related changes in the normal human ear. Forensic Sci Int. 2009;187:110.e1–7.

    Article  PubMed  Google Scholar 

  59. Arora G, Arora S. Rejuvenating earlobe esthetics with dermal fillers. J Cosmet Dermatol. 2022;21:2788–92.

    Article  PubMed  Google Scholar 

  60. Dickens ST, Sarver DM, Proffitt WR. Changes in frontal soft tissue dimensions of the lower face by age and gender. World J Orthod. 2002;3:313–20.

    Google Scholar 

  61. Pessa JE, Slice DE, Hanz KR, Broadbent TH, Rohrich RJ. Aging and the shape of the mandible. Plast Reconstr Surg. 2008;121:196–200.

    Article  CAS  PubMed  Google Scholar 

  62. Shadfar S, Perkins SW. Anatomy and physiology of the aging neck. Facial Plast Surg Clin North Am. 2014;22:161–70.

    Article  PubMed  Google Scholar 

  63. Engerer N, Frank K, Moellhoff N, Alfertshofer M, Giunta RE, Green JB, Lorenc PZ, Chaney GK, Ehrl D, Cotofana S. Aging of the neck decoded: new insights for minimally invasive treatments. Aesthet Plast Surg. 2022;46:1698–705.

    Article  Google Scholar 

  64. Rohrich RJ, Pessa JE. The subplatysmal supramylohyoid fat. Plast Reconstr Surg. 2010;126:589–95.

    Article  CAS  PubMed  Google Scholar 

  65. Windhager S, Mitteroecker P, Rupić I, Lauc T, Polašek O, Schaefer K. Facial aging trajectories: a common shape pattern in male and female faces is disrupted after menopause. Am J Phys Anthropol. 2019;169:678–88.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Paes EC, HJLJM T, Koop WA, Kon M. Perioral wrinkles: histologic differences between men and women. Aesthet Surg J. 2009;29:467–72.

    Article  PubMed  Google Scholar 

  67. Jacobs LC, Liu F, Bleyen I, et al. Intrinsic and extrinsic risk factors for sagging eyelids. JAMA Dermatol. 2014;150:836–43.

    Article  PubMed  Google Scholar 

  68. Reitsma MB, Kendrick PJ, Ababneh E, et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the global burden of disease study 2019. Lancet. 2021;397:2337–60.

    Article  Google Scholar 

  69. Rossi AM, Eviatar J, Green JB, et al. Signs of facial aging in men in a diverse, multinational study: timing and preventive behaviors. Dermatol Surg. 2017;43:S210–20.

    Article  CAS  PubMed  Google Scholar 

  70. Buziashvili D, Tower JI, Sangal NR, Shah AM, Paskhover B. Long-term patterns of age-related facial bone loss in black individuals. JAMA Facial Plast Surg. 2019;21:292–7.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

The authors would like to acknowledge Akriti Choudhary, MBBS, for editorial assistance with this chapter, as well as Shreya Raman MD for contributing original illustrations.

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Correspondence to Chad A. Purnell .

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Purnell, C.A., Cohen, M.N. (2024). Anatomy of the Male Aging Face. In: Thaller, S.R., Cohen, M.N. (eds) A Comprehensive Guide to Male Aesthetic and Reconstructive Plastic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-48503-9_15

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