Facial Aging Explained

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

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 seems 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. 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’s a very basic lesson on face structure: your outer skin (epidermis) is packed from the inside with the hypodermis (also known as subcutis), which is where all your (appropriately named) subcutaneous fat is found. The hypodermis is what connects to the web of your facial muscles, which in turn link to your perfect bone structure. We’ll explore these elements from inside out, starting with 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, based on a recent article from the Journal of Plastic and Reconstructive surgery, 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 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 is a CB-approved dermatologist with vast experience in lasers and other cutting-edge anti-aging technologies. When bones migrate and lose density, she explains, “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 mentioned by Dr. Weishar, unveils “jowls and an unstructured neck,” says 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; check out this video) and ultherapy are great examples of preventive procedures you can do every couple years.


Etching + Sagging

That underlying structure of facial muscles mentioned above is called the superficial muscular aponeurotic system (SMAS), which 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 superficial muscular aponeurotic system aka SMAS) loses its elasticity, culminating in a true domino effect.”

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.”

Solutions: as Dr. Weishar mentions, etched-out muscle lines can be erased using carefully placed Botox.


Disappearing + Drifting

As babies, our faces are round and full of pudgy, subcutaneous pockets of fat. As this Harvard Health article so accurately 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. Those pockets 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. Says 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. 


We always like to include the latest theories: according to Dr. Weishar, there might be more at play than the elements listed above. Says Dr. Weishar, “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 as well for skin tightening—but I believe it should be balanced with addressing volume loss underlying the skin as well.” If you’re curious about the skin-stretching theory, check out this article.

Image: Kathryn Miller


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


Learn more about Dr. Margo Weishar and Dr. Shereene Idriss by visiting Charlotte’s Book, where you can read client reviews, book appointments, and get expert advice from other professionals. Only the best cosmetic doctors, skincare gurus, nutritionists, fitness and wellness professionals make it into our book.

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