Facial bone structure changes with age

It turns out that it’s more than just the skin and facial fat that undergoes changes as our faces ages. There are changes in the actual shape of the underlying facial skeleton, too.
The most recent issue of PRS has an article on this topic, in which CT scans of the facial bones in young, middle-aged, and older age groups were compared. The results: there are a number of significant structural changes that occur in all areas of the face as we age. Overall, the facial skeleton loses volume as we age (which we knew), but more so in particular zones: the eye socket, the midface and the mandible (jawbone).
I was amazed by the CT images showing the change in shape of the eye socket. Both the upper rim and the lower outer rim of the orbit seem to melt away over the years, significantly changing the shape of the eye socket, and making it wider, longer and larger in area. Aging also affected the bones of the middle part of the face (maxilla) and the mandible in visually obvious ways.
(Image from AAPS.org. Aging of the Facial Skeleton: Aesthetic Implications and Rejuvenation Strategies. Robert B. Shaw, Jr., et al.)
What does this mean? Plastic surgeons need to remember that the bony framework changes too, as we age. It’s not just about tightening up the skin, or adding volume to the face with fat or fillers. To help make someone look more youthful, we should analyze the patient and think about whether or not the facial skeleton needs to be corrected, in addition to looking at skin laxity or the loss of facial fat, like we usually do.
Maybe that blepharoplasty (eyelid tuck) would look even better if we put in a small implant to restore the shape of the bone to its original youthful contour. Dr. Flowers (in Honolulu) has been doing this for years – maybe he’s on to something!