Understanding the process of facial aging is essential for developing effective aesthetic treatments. By examining the face in three distinct regions—the upper, middle, and lower thirds—we can gain insights into the specific changes that occur with age and how these changes affect overall appearance. This regional approach provides a comprehensive understanding of the aging process and aids in the creation of targeted treatments.
Upper Third: Forehead, Glabellar Area, and Eyebrows
The upper third of the face, including the forehead, glabellar area, and eyebrows, undergoes several significant changes with age.
Wrinkle Formation: One of the earliest signs of aging in this region is the appearance of wrinkles. Horizontal forehead lines result from repetitive contraction of the frontalis muscle, while vertical lines in the glabellar area are caused by the action of the corrugator supercilii and procerus muscles.
Changes in Eyebrow Position: The position of the eyebrows changes due to both bone and soft tissue alterations. Recession of the superior orbital rim leads to brow ptosis, or drooping. Additionally, decreased activity of the frontalis muscle and increased tone of the orbicularis oculi muscle contribute to the downward displacement of the brows. This effect is more pronounced in the lateral portions of the eyebrows due to the anatomical positioning of the frontalis muscle.
Temporal Region Fat Loss: The temples experience a noticeable decrease in soft tissue thickness with age, leading to a concave appearance. Magnetic resonance imaging studies confirm that the soft-tissue thickness of the temporal region decreases by an average of 3.4 mm throughout adulthood. This loss of volume can be dramatic, contributing to a hollow and aged look.
Middle Third: Periorbital Area, Nose, and Midface
The middle third of the face, which includes the periorbital area, nose, and midface, shows some of the earliest signs of aging.
Periorbital Changes: The periorbital area undergoes significant changes with age. Bony recession of the orbital rim increases the width and area of the orbital aperture, making the eyes appear smaller and rounder. Fat loss in the superomedial orbit, nasojugal groove, and palpebromalar junction contributes to the hollowing around the eyes. The descent of the lateral canthus and infraorbital fat herniation lead to scleral show and tear trough formation, which make the eyes look sunken and tired.
Nasal Changes: Aging affects the supportive structures of the nose, leading to tip ptosis and nasal lengthening. Recession of the pyriform fossa and upper maxillary resorption contribute to a droopy nasal tip and a narrower nasolabial angle. The lower lateral cartilages flatten and the interdomal ligaments weaken, exacerbating tip ptosis and sometimes giving the illusion of a dorsal hump.
Midface Volume Loss: The midface loses volume as the deep fat pads deflate and the superficial fat pads descend. This results in the flattening of the ogee curve and an increase in concavity of the submalar region. Bony changes, such as a decrease in maxillary angle and height, further contribute to the hollowing of the midface. The loss of cheek projection and the descent of the overlying soft tissues lead to the formation of nasolabial folds and a more aged appearance.
Lower Third: Perioral Region, Chin, and Jawline
The lower third of the face, encompassing the perioral region, chin, and jawline, undergoes notable changes with age.
Perioral Region Changes: The perioral region experiences a loss of definition, shape, and fullness. The lips flatten and retrude, the vermilion border becomes less pronounced, and perioral wrinkles and folds form. The orbicularis oris muscle, which surrounds the mouth, weakens and thins, contributing to the loss of lip pout and the formation of vertical lip lines. These changes are often exacerbated by repetitive muscle contraction and smoking.
Chin and Jawline Alterations: The chin loses projection and shape due to bone resorption and muscle changes. The mandible recedes, leading to the formation of pre-jowl sulci and an increase in the labiomental crease. Fat loss in the chin area can increase the prominence of these features and contribute to chin ptosis. The jawline becomes less defined as the cervicomental angle increases and jowls become more pronounced. This is due to a combination of mandible recession, fat compartment descent, and skin laxity.
The regional approach to understanding facial aging highlights the specific changes that occur in the upper, middle, and lower thirds of the face. By recognizing these changes, doctor can develop targeted treatments that address the unique needs of each facial region. This comprehensive understanding of facial aging allows for more effective and harmonious rejuvenation strategies, ultimately improving patients’ self-perception and social interactions.