In addition to changes in the appearance of our skin and volume of facial fat, our skulls morph with time and contribute to our aged appearance.
Several scientific articles have identified some of these changes. The areas that mainly change are our orbital rims and cheekbones. These changes mostly affect the central part of our face. As infants, the configuration of the central part of our face is relatively compact. As we become young adults, more space develops in the central part of our face. Once we age, however, changes in our orbital rims and cheekbones make our central face more compact again. The picture above highlights the differences between the skulls of a young and older person. *
As our central face becomes more compact, the muscles, fat, and skin attached to the bones bunches together to a certain degree. What this translates to is illustrated by the following picture. This picture shows a great example of both a young and aged face with almost no overlying fat. You can clearly see the differences in the shapes of the underlying skeleton and how the skin of the older face bunches together because there is less bony support. **
Knowing that our skull changes with age, we can augment the deficiencies that develop with time using products like Sculptra and Radiesse. The more we learn about how all aspects of our face change with age, the better we can become at rejuvenating it.
* Shaw RB Jr, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 2007: 119: 675–681.
** Vleggaar D, Fitzgerald R. Dermatologic implications of skeletal aging: a focus on supraperiosteal volumization for perioral rejuvenation. J Drugs Dermatol 2008: 7 (3): 209–220.
*** Fitzgerald R, Vleggar D. Facial volume restoration of the aging face with poly-l-lactic acid (pages 2–27). Dermatol Therapy 2011.