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The Four Pillars Of Aging: What Actually Happens To Your Face As You Age


July 1, 2021

For anyone looking in the mirror on a daily basis (hey, beautiful), the first signs of aging are on the surface: darker undereye circles that seem somehow larger than the last time, a pair of lines between your eyebrows, an odd collection of extra skin and fat at the bottom of your jaw.

But those outward changes are the result of deeper structural changes in your bones, muscle, and fat, and the seismic moves happening underneath your skin make a big difference in how you age.

Of course, people like Michelle Pfeiffer (pictured above) have somehow defied the odds and look even more beautiful as they age. Good facial structure? Good diet? I probably chalk it up to both. But clearly genetics plays a key role. We reached out to several dermatologists to outline the key aspects of facial aging.

Here, we outline the four pillars of facial aging.


The four major areas of structural change are bone, muscle, fat, and finally, skin. But before we dive into the woes of aging, here are the basics of face structure: your outer skin (epidermis) is packed from the inside with the hypodermis (also known as subcutis), which is where all your subcutaneous fat is found. The hypodermis is what connects to the web of your facial muscles, which in turn link to your bone structure. We’ll explore these elements from inside out, starting with the bone.


Migrating + Losing Density

Despite their rigidity, bones don’t stay the same as we age—they lose mass, migrate, and cause major changes in our appearance. This outline from Live Science on how our bones age explains how the eye sockets, nose, and jaw are major migration points. “The facial skeleton experiences morphologic change, and an overall decrease in volume, with increasing age,” researchers wrote in the Journal of the American Society of Plastic Surgeons.

According to Dr. Margo Weishar, a CB-approved specialist in clinical and cosmetic dermatology, “Bone loss in the face can lead to narrowing of the temples and retraction of the jawline and mouth. The nose starts to descend.”

Dr. Shereene Idriss, a dermatologist with vast experience in lasers and other cutting-edge anti-aging technologies, explains what happens when bones migrate and lose density. “The orbital rim (aka eye socket) widens, particularly along the outer inferior edges, giving your eyes a more sunken appearance with more prominent fat pads resulting in a tired look.” That retraction of the jawline that Dr. Weishar mentioned, unveils “jowls and an unstructured neck,” says Dr. Idriss.

The kicker? Most of these changes happen much earlier in women—between young and middle age—and much later in men—between middle and old age.

Solutions: There are no skeletal approaches to anti-aging, but there are preventive procedures to avoid sagging. Keeping the skin taut is the best approach here. “Heat is a potent source of energy that allows fibrous bands to tighten while stimulating new collagen to develop,” explains Dr. Idriss. Radiofrequency (a favorite of Joanna Vargas) and ultherapy are great examples of preventive procedures you can do every couple of years.


Etching + Sagging

That underlying structure of facial muscles mentioned above is called the superficial muscular aponeurotic system (SMAS), and it sits between bone and fat. When bones give way, the muscles follow.

Dr. Idriss puts it this way: “The facial muscles and fat pads decrease in volume, while the casing holding them together (the SMAS) loses its elasticity, culminating in a true domino effect.”

Solutions: Before this loss of volume takes place, your muscles have the chance to work up lines from repetitive motions. “Muscular activity can result in “etched-in” lines due to repeated motion, explains Dr. Weishar. “This is where Botox/Dysport/Xeomin can really help—both in preventing and reversing early lines before they set in.”


Disappearing + Drifting

As babies, our faces are round and full of pudgy, subcutaneous pockets of fat. As this Harvard Health article describes, that fat diminishes and rearranges itself slowly but surely, finding new pockets to inhabit as we age. Usually, those pockets aren’t high on our cheekbones or perfectly arranged to balance our eyebrows and eyes. They drift downward, clumping around the chin, jaw, and neck.

This movement happens in your forties, in particular, and continues steadily as the years pass. Dr. Heidi Waldorf, Director of Laser and Cosmetic Dermatology at The Mount Sinai Medical Center in New York City, told Women’s Health, “Although there are variations due to genetics, in general we lose the deep fat pads in the mid-face and those of the temples and the front of the ears first. Then we lose [fat] around the mouth and chin and along the jawline.”

The result? It looks like your skin is falling and wrinkling (which it is) but the underlying cause is the deflation of fat.

Following the path of sagging skin, the perky button nose of your youth starts to turn downward. According to Dr. Waldorf, “This is partly due to lack of soft tissue support and also a result of the upper lip retracting downward and the nose following. The top of the nose at the bridge often sinks, causing a horizontal wrinkle, in addition to the vertical lines between the brows.”

Solutions: In this case, wrinkles are the primary target (rather than overall sagging or muscle, though of course, as we’re learning, everything’s related). Consider filler for crow’s feet and forehead wrinkles, combined with the radiofrequency, lasers, and ultherapy mentioned above.


According to Dr. Weishar, there might be more at play than the elements listed above: “There is an interesting theory recently being floated around that what really happens in aging is that the skin starts to expand and lose its elasticity, rather than the support being lost.”

It could be that your skin is just losing elasticity and stretching—simple as that—rather than this four-stage aging process. “Although I feel this is partially true,” Dr. Weishar continues, “I still believe it is a combination of both. So there is a role for skin tightening—but I believe it should be balanced with addressing underlying volume loss as well.” If you’re curious about the skin-stretching theory, check out this article.

Photo credit: Michelle Pfeiffer in French Exit.


There’s an array of anti-aging treatments depending on what stage of aging you find yourself in.
We have guides for the 20s and 30s, 40s, and 50s and 60s


Read client reviews, book appointments, and get advice from the experts in Charlotte’s Book. Only the best cosmetic doctors, skincare gurus, nutritionists, and fitness and wellness professionals make it into our book.



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