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Are you unhappy with the sunken or flattened look of your face or with the skin sagging?
Do you have hollowed cheeks, flattened cheek bones, marionette lines, nasolabial folds, under the eye hollows, down sloping mouth corners, sagging skin in the cheek area and in the jawline, deflated temples or drooping skin in general? |
Visual signs of the facial volume loss
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- Go to other options to replace the lost volume, click here;
- See the summary of all options to replace facial volume, click here;
- To understand the reasons for for the facial sagging and volume loss, keep on reading.
Content of this page -
I. Deflation of the Deep Fat Pads. The Triangle of Youth and the Square of an Aged Face
II. Face Anatomy and Its Layers
III. Face Layer Aging Sequence
IV. Structure of the Fat Layers. Deep Fat Compartments and Superficial Fat Compartments
V. Volumetric Facial Aging - Deflation of the Deep Fat Pockets
VI. Where the Volume is Actually Lost vs. Where the Loss is Visible. The Implications
VII. References and Literature
I. Deflation of the Deep Fat Pads. The Triangle of Youth and the Square of an Aged Face
II. Face Anatomy and Its Layers
III. Face Layer Aging Sequence
IV. Structure of the Fat Layers. Deep Fat Compartments and Superficial Fat Compartments
V. Volumetric Facial Aging - Deflation of the Deep Fat Pockets
VI. Where the Volume is Actually Lost vs. Where the Loss is Visible. The Implications
VII. References and Literature
Clinical observations and laboratory investigations in the past 12 years have advanced understanding of the very complex facial anatomy. They demonstrated that the age-related deflation of the deep fat pads on the face results in a diminished support of the overlaying tissues and skin, and leads to their descent and drooping (Rohrich, 2007). That makes a face look flatter and squared, whereas a youthful face is characterized by a triangular shape and a 3-dimensional volume.
The Triangle of Youth and the Square of an Aged Face. Facial shape changes as we age.
In our late 30’s and 40’s, loss of facial volume from the age-related deflation of the deep fat pads on the face is the main factor contributing to the hollowed, sagging, flattened and, hence, aged look of the face.
In this publication, we focus on these aging volume changes specific to people in their late 30’s and 40’s.
We then provide a comprehensive list of options to restore the facial volume and shape, and, hence, a youthful look of the face.
In this publication, we focus on these aging volume changes specific to people in their late 30’s and 40’s.
We then provide a comprehensive list of options to restore the facial volume and shape, and, hence, a youthful look of the face.
Face Anatomy and Its Layers
Our faces have a layered structure. Think of a face as of an onion or a cabbage, where each layer is different though.
The facial structure layers that are relevant to the aging process, aged appearance and, hence, to restoring the youthful look, are:
The facial structure layers that are relevant to the aging process, aged appearance and, hence, to restoring the youthful look, are:
Facial anatomy. The layers of the face.
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Note: The layers also slightly differ between these three regions:
1. the forehead,
2. the eyes and the lip-and-mouth area,
3. the rest of the face - lower and middle face.
Every layer changes differently, at a different pace, and so these three areas of the face will also age differently
1. the forehead,
2. the eyes and the lip-and-mouth area,
3. the rest of the face - lower and middle face.
Every layer changes differently, at a different pace, and so these three areas of the face will also age differently
Face Layer Aging Sequence
Each of those layers starts aging, that is deteriorating functionally and structurally, at a different age. Each layer ages at its own pace, under the influence of different intrinsic and extrinsic factors, and provides its own unique contribution to the aged look of the face.
General layer aging sequence by age decade, varies by person -
In our 20-s - skin: dermis and epidermis start aging and loss of the deep fat pockets under the eyes begins
In our 30-s - plus all deep fat pockets start deflating and loss of the muscle tone begins
In our 40-s - plus retaining ligaments, fascia, and spaces start stretching
In our 50-s - plus bone loss begins.
In our 20-s, the outer expression of aging begins with the diminishing quality of the skin (layer 1), which is caused by the loss of and deterioration of quality of the hyaluronic acid, collagen and elastin in the skin, thickening of the epidermis and thinning of the dermis, changes in the pigment producing cells, dilation of capillaries. Visibly this is manifested as fine lines and smaller wrinkles, pores, little veins/capillaries on the face, discoloration, diminished plumpness of the skin and an overall dull complexion. In our late 20’s we also start losing deep fat around the eyes (Wan, 2013).
The skin quality continues to deteriorate with the age, and then beginning in our 30s, other the deep fat compartments, layer 5 start deflating.
This loss of the facial volume and, consequently, drooping of the overlaying tissue becomes one of the major contributors to the aged look of depletion and sagging in this age group.
Let’s have a closer look at the two fat layers of the face – the superficial fat layer (layer 2 on the picture), aka subcutaneous fat, and the deep fat layer (layer 5 on the picture) – and their aging.
General layer aging sequence by age decade, varies by person -
In our 20-s - skin: dermis and epidermis start aging and loss of the deep fat pockets under the eyes begins
In our 30-s - plus all deep fat pockets start deflating and loss of the muscle tone begins
In our 40-s - plus retaining ligaments, fascia, and spaces start stretching
In our 50-s - plus bone loss begins.
In our 20-s, the outer expression of aging begins with the diminishing quality of the skin (layer 1), which is caused by the loss of and deterioration of quality of the hyaluronic acid, collagen and elastin in the skin, thickening of the epidermis and thinning of the dermis, changes in the pigment producing cells, dilation of capillaries. Visibly this is manifested as fine lines and smaller wrinkles, pores, little veins/capillaries on the face, discoloration, diminished plumpness of the skin and an overall dull complexion. In our late 20’s we also start losing deep fat around the eyes (Wan, 2013).
The skin quality continues to deteriorate with the age, and then beginning in our 30s, other the deep fat compartments, layer 5 start deflating.
This loss of the facial volume and, consequently, drooping of the overlaying tissue becomes one of the major contributors to the aged look of depletion and sagging in this age group.
Let’s have a closer look at the two fat layers of the face – the superficial fat layer (layer 2 on the picture), aka subcutaneous fat, and the deep fat layer (layer 5 on the picture) – and their aging.
While the layer concept describes the layered anatomy of the face, the superficial and deep fat layers of the face are actually not a confluent contiguous mass. Recent laboratory studies of the facial anatomy have demonstrated that the facial fat is partitioned or compartmentalized into discreet pockets of fat (Rohrich, 2007). These separate fat compartments are created/separated by fascial membrane, or by, in other words, an outgrowth of the connective tissue called fascia.
As described in the section on the Facial Anatomy Layers, deep fat compartments lie deep underneath the mimetic muscles of the face, close to the bone.
As described in the section on the Facial Anatomy Layers, deep fat compartments lie deep underneath the mimetic muscles of the face, close to the bone.
The deep fat layer of the face consists of discreet compartments, or fat pockets, separated by connective tissue
The subcutaneous (superficial fat) layer right underneath the skin is comprised of distinct separate fat compartments. It is closely attached to the skin
Volumetric Facial Aging - Deflation of the Deep Fat Pockets
It is not entirely clear why (Wan, 2013), but superficial fat pockets and deep fat pockets age differently and play different roles in the aged look of a face.
In a person with a stable weight (if there is no major weight loss), -
1. Deep fat pockets start deflating around eyes in our late 20’s, and then in our 30-s other deep fat pockets on the cheeks and temples begin deflating too (Donofrio, 2000; Gierloff, 2012).
2. Superficial fat pockets persist throughout life (Rohrich, 2007), unless there is a major weight loss. They contribute to the drooping and sagging look of the aging face.
3. Then the overlaying skin, connective tissue and the superficial fat pads (Layers 1 through 4, see picture facial layers) lose the support of the now deflated deep fat pockets, and start hanging and draping along the anchoring muscle and retaining ligaments lines/points, and we start observing the “valleys” on the face: the cheek region, near the eyes and on the temples. And “folds occur at transition points between thick and thinner superficial fat compartments” (Rohrich, 2009).
That is why we no longer think that it is the stretching of the facial tissue alone, under the forces of gravity, that is mostly responsible for the facial aging.
That is what is called the volumetric theory of facial aging (Lambros, 2007).
In a person with a stable weight (if there is no major weight loss), -
1. Deep fat pockets start deflating around eyes in our late 20’s, and then in our 30-s other deep fat pockets on the cheeks and temples begin deflating too (Donofrio, 2000; Gierloff, 2012).
2. Superficial fat pockets persist throughout life (Rohrich, 2007), unless there is a major weight loss. They contribute to the drooping and sagging look of the aging face.
3. Then the overlaying skin, connective tissue and the superficial fat pads (Layers 1 through 4, see picture facial layers) lose the support of the now deflated deep fat pockets, and start hanging and draping along the anchoring muscle and retaining ligaments lines/points, and we start observing the “valleys” on the face: the cheek region, near the eyes and on the temples. And “folds occur at transition points between thick and thinner superficial fat compartments” (Rohrich, 2009).
That is why we no longer think that it is the stretching of the facial tissue alone, under the forces of gravity, that is mostly responsible for the facial aging.
That is what is called the volumetric theory of facial aging (Lambros, 2007).
On the picture, you can see the difference between where the volume is actually lost and where the volume deficiency is perceived visually.
Starting in our late 20's, we begin loosing volume in the deep fat compartments (purple). That deflation is visible as valleys, folds, and sagging (blue). For the most natural looking treatment results, the volume should be restored where it is actually lost.
To summarize, -
- Deep fat pads deflate with the age.
- No longer supported by the sufficient deep fat volume inside, the skin and the attached superficial fat start descending and hanging down and draping like an overly spacious piece of clothing on a smaller frame.
If there is a major weight loss
In this age group, weight loss due to intensive working out, stress and/or dieting may also lead to the loss of the superficial facial fat exacerbating the hollowed and sunken appearance of the cheeks, temples and under the eyes. In response to stress or extreme dieting, some people may lose up to 35% of their mid face fat/volume in one year. This loss of volume would come from the thinning of the superficial fat compartments.
Understanding these anatomical features and the anatomy of aging lies behind understanding what options we have to restore a youthful look of the face. Particularly, note where the fat is actually lost, in the deep fat pads (see picture above) versus where the perceived volume loss is – the valleys (folds and hollows). What is the implication?
To achieve the natural looking rejuvenation results, the volume should be restored where it is lost, not necessarily where the loss volume is visible.
The publication Restore Facial Volume describes all available options to replenish the lost volume and restore the youthful look.