Facial aging is the result of changes to several types of soft tissue, including skin, fat, muscle and bone. Each structure ages differently, and the aging of one structure impacts on another, cumulatively changing how we age.

The skin can be considered as the canvas that covers all the other structures that influence facial aging, and although a beautiful duvet cover will make a bedroom look stunning, the basic structure of the bed and the mattress is important as well. In the past, plastic surgeons focused exclusively on the skin when trying to achieve a more youthful look, resulting in the so-called “wind tunnel” look, with tautly pulled skin over gaunt bony structures. Today we understand the anatomy of facial aging far better.

We’ve all pinched the full cheek of a baby, and we know that a youthful look depends on having the right amount of facial fat in all the right places. Facial volume loss is caused by the redistribution, accumulation or atrophy of fat. As we age, some areas of the face lose fat, and others gain fat. Patients that have more facial fat volume as they age generally appear more youthful.

Today we have several treatment options available to reposition fat and to add volume to the face.
In the photograph below, meet two identical twins. And somehow the one appears older than the other. The twin on the left has a higher body mass index than the twin on the right – showing the role facial volume loss can play.

As we age there is also a significant loss of facial bone. Without the structural support of bone, there are noticeable changes in the layers of overlying soft tissue and skin. The result of this combination of factors is visible signs of ageing, including greater visibility of all the bony landmarks, lines and wrinkles, together with prominent transverse forehead lines, more prominent nasolabial lines, loose skin over the mid-face, changes in the area around the mouth and lips, and the development of marionette lines.

Aging of each of these factors will be different for each patient, and the art of plastic surgery is centered around developing a solution for each patient to achieve symmetry, smooth contours, even skin tone and texture and a subtle and harmonious transition between the anatomical regions of the face.

The modern approach to facial rejuvenation includes attention to all soft tissue – we tighten muscles, we add and reposition volume, and we re-drape healthy looking skin over the newly enhanced structures.