According to study results recently released by a team of plastic surgery researchers, it is not only fat and collagen depletion that contributes to an aged facial appearance over time, but also a gradual loss of bone volume.
This “milestone” study, according to American Society of Plastic Surgeons President Dr. Phil Haeck, brings surgeons one step closer to understanding why skin tightening alone with procedures such as a facelift, eyelid lift or brow lift may not be enough to restore a youthful appearance.
“The original thought was that skin goes through changes, such as a loss of elasticity and fat, so the primary approach to facial rejuvenation was skin tightening procedures,” study co-author Dr. Robert Shaw Jr. told HealthDay News.
“But a lot of faces never looked like they did when they were younger. Patients bring in pictures and say they want to go back to that look, but they can never really go back to that look just by tightening their skin alone. If there are changes to those underlying structures it’s going to change the appearance of how the skin looks.”
Study results, which are published in the January issue of Plastic and Reconstructive Surgery, indicate that bone loss and recession is most pronounced in women over 40 and men over 65. Study authors performed CT scans on 120 Caucasian patients (60 men and 60 women) split into three age categories—20-40 years, 41-64 years and 65 years and older.
“We saw changes around the eye, and then in the cheek area and in the jaw,” study co-author Dr. Howard Langstein told NPR. “And if you think about it, it kind of makes sense. When people age, the eyes appear hollow, deep-set. And, in fact, that’s what we found. The cheek bones right beneath the eye socket descend somewhat and come back in. As a result, they don’t give as much support to the lower eyelid.”
Langstein also said that chin recession and thinning of the jawbone were also major contributors to facial aging, explaining the slack-jawed appearance of some of the study’s oldest participants.
To combat the effects of bone loss on facial aging, Dr. Shaw suggest combining skin tightening with other cosmetic procedures designed to restore the facial structure, such as fat grafting, injections with fillers like Radiesse or Sculptra and facial implants for the chin, cheeks and jaw.
“It’s not ever possible to bring someone back to how they looked when they were 20 years old, but adding volume back to the face can improve results for some patients,” says Dr. Shaw.
Since bones makeup the underlying structure of the skin and provide a sort of scaffold to support facial tissues, the study results are no surprise to cosmetic surgeons.
“It’s one of those things that, in retrospect, you sort of say, ‘Duh, I should have known that!’” says Dr. Langstein. “Nothing stays the same on the body. Everything ages.”