Pathogenesis of the Aging Face
An individual’s facial contours and appearance are derived from soft tissue draped over underlying bone. The soft-tissue component consists of skin, subcutaneous fat, muscle, deeper fat pads, and fascial layers. The underlying structural element is composed of bone, cartilage, and teeth.
As the face ages, the soft-tissue component descends, and the bone component loses mass. With these changes, relatively more soft tissue hangs from its attachments to the bone. Loss of subcutaneous fat, skin atrophy, and descent of facial fat pads compound this facial sagging. Around the eyes, the lateral brow typically descends more than the medial brow, which leads to temporal hooding. The orbital septum attenuates, allowing fat to prolapse forward. In the lower eyelid, midface descent produces the skeletonization of the infraorbital rim and increases the prominence of the orbital fat. Sagging of the platysma muscle in the neck posterior to the mandibular ligament gives rise to jowling.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.