Can applying makeup upwards help delay jawline sagging and definition loss with age?

October 17, 2024

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healthcaretoday, AMSC2024, facial aging, aging, perioral lines, marionette lines, lip atrophy, Dr Konstantin Frank, sagging skin, bone loss, jawline, drooping appearance, anti-aging, aesthetic medicine, chin implants,
​​​​​​​​​As we age, the perioral region, which includes the lips and surrounding areas, reveals the most visible signs of aging. Perioral lines, marionette lines, barcode lines, lip atrophy, and the deepening of nasolabial folds all contribute to an aged appearance. One of the primary aging shifts is the volume loss from the upper and middle thirds of the face to the lower third. This descent is what patients typically seek treatment for, leading to the popular practice of tissue lifting through repositioning.

Understanding aging beyond the surface
“Aging is not just about macroscopic changes but occurs at the molecular and cellular levels,” says Dr Konstantin Frank (pix), an expert in facial plastic anatomy from Ludwig-Maximilians-University of Munich. Speaking at the recent Aesthetic Medicine & Surgery Conference & Exhibition (AMSC), Dr Frank explained the complexity of aging, emphasizing the role of DNA methylation, protein synthesis, and molecular changes that come with age.

The role of bone in facial aging
Many people are unaware of the critical role bone plays in facial aging. The face consists of various layers, including the skin, fat, fascia, and bone. Bone loss and changes, especially in the skull and facial bones, significantly impact the appearance of aging. According to Dr Frank, bone resorption and calvarial contraction—where the skull volume diminishes—are key drivers of age-related changes in facial structure.

This skeletal shift causes the deep fat layer to descend, leading to visible sagging. “It’s not the skin but the deep fat layer that falls as we age,” Dr Frank explains. For example, the temporal hollowing and skeletalization around the eyes are largely due to bone loss rather than fat or muscle tissue.

Midface and jawline: Changes in bone structure
In the midface, the maxillary bone tilts with age, causing a further descent of soft tissues. This results in a drooping appearance, which is often managed through soft tissue adjustments. However, the root cause lies in the bone structure.

One of the most pronounced signs of aging occurs in the mandibular region. Bone volume loss, particularly around the mandibular angle, leads to jawline sagging and the loss of definition. According to Dr Frank, “Reestablishing the lost bone volume is challenging, but certain surgical techniques like chin implants can improve neck and jawline definition.”

Fat: A complex layer of aging
Facial fat changes as we age, and understanding these changes is essential for effective treatment. There’s a common misconception that aging only involves fat loss, but the reality is more nuanced. Superficial fat is divided into compartments, and only specific areas—such as the nasolabial and jaw fat compartments—descend with age. This descent contributes to the deepening of the nasolabial folds and the formation of jowls.

Dr Frank highlights that jowling is a superficial process, often linked to septosis (sagging) of the submandibular gland. On the other hand, deep fat undergoes volume loss, which requires deep injections for rejuvenation. "Deep fat injections are key to achieving natural results, as they restore volume in a way that mimics the natural physiology of the face," he explains.

The importance of layered treatment approaches
As facial aging occurs across multiple layers—skin, fat, fascia, and bone—a one-size-fits-all treatment approach is insufficient. Dr Frank stresses the need for a comprehensive strategy that addresses each layer individually. Superficial fat, for instance, moves more than deep fat, which can create an unnatural expression when fillers are overused in the superficial layers.

Additionally, the complexity of facial anatomy means that certain areas, such as the jawline, contain critical arteries and nerves. “Injecting too deeply in the jawline can be risky due to the proximity of arteries and veins. Therefore, practitioners must be mindful of anatomical structures when treating aging in the jawline and other sensitive areas.

Combining treatments for optimal results
Addressing facial aging requires a combination of treatments to achieve balance between surface aesthetics and underlying structure. This may include improving skin quality, replacing lost volume, and correcting sagging. Achieving good results involves using several tools in combination to treat both the surface and deeper layers effectively.

The latest advances in aesthetic medicine highlight the importance of understanding the deeper causes of aging. By decoding the layers of facial anatomy and applying targeted treatments, practitioners can deliver more natural and lasting anti-aging solutions.

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