The Facial Aging Process From the “Inside Out”

Abstract

The normal course of aging alters the harmonious, symmetrical, and balanced facial features found in youth, not only impacting physical attractiveness but also influencing self-esteem and causing miscommunication of affect based on facial miscues. This evidence-based paper aims to provide a comprehensive overview of the latest research on the etiology and progression of facial aging by explaining the aging process from the “inside out”; that is, from the bony platform to the skin envelope. A general overview of the changes occurring within each of the main layers of the facial anatomy are presented, including remodeling of the facial skeleton, atrophy or repositioning of fat pads, changes in muscle tone and thickness, and weakening and thinning of the skin. This is followed by an in-depth analysis of specific aging regions by facial thirds (upper, middle, and lower thirds). This review may help aesthetic physicians in the interpretation of the aging process and in prioritizing and rationalizing treatment decisions to establish harmonious facial balance in younger patients or to restore balance lost with age in older patients.

Application of Nonsurgical Modalities in Improving Facial Aging

“…The elasticity of the skin primarily depends on the dermis with collagen playing the primary role. With internal aging of the skin, the synthesis rate of collagen decreases and its degradation rate increases [ 7 ]. Moreover, the decomposition of collagen was increased by upregulating protease [ 8 ].…”

“…Facial bones support the facial soft tissues. In the aging of facial bones, the most obvious change is the change in the mandibular angle from an L-shape to an I-shape, which leads to mandibular protrusion and changes in the mandibular line [ 7 ]. In addition, the zygomatic arch undergoes anteroposterior reconstruction, thus deepening the zygomatic fossa.…”

“…The nasal cavity expands outward and forward, and the upper and olfactory cavities remain intact, thus resulting in the enlargement of the piriform foramen. The rim of the eye socket expands downward and outward, thus causing the socket to lose its roundness, and the chin becomes more protrusive, oblique, and short [ 7 ].…”

Facial Skin Aging Stages in Chinese Females

“…Skin aging is a complex biological behavior ( 1 ) involving changes in multiple skin physiological parameters ( 2 ) and appearance characteristics ( 3 ) and has attracted considerable attention from researchers in many disciplines. It consists of two independent processes: endogenous aging is mainly controlled by genes ( 4 ), and exogenous aging is mainly affected by solar radiation ( 5 ).…”

“Mini-V lift” Facelifting

“…Wrinkles, folds, poor skin texture and sagging or imbalanced distribution of the soft tissue are the main signs of the facial aging, which may alter the self-perception by psychological, emotional and social effects [1][2][3]. A youthful face is featured with more positive feelings because of facial harmony, while facial aging may affect negative interpersonal relationships by changing the personal emotions to anger, tiredness or sadness [1,2,4,5]. In recent, the desire of the most patients are getting increased toward a dramatic cosmetic improvement while having less invasive procedure with shorter downtime, less postoperative complication and less visible scar.…”