Facial aging is commonly associated with wrinkles, sagging skin, and the loss of soft tissue volume, but these changes are only part of a complex process. The foundation of the face, the skull, undergoes continuous structural changes that drive many visible signs of aging. Since this skeletal framework supports the muscles, fat, and skin, its alteration significantly impacts the facial contour over time. Three-dimensional imaging confirms that the facial skeleton experiences a measurable decrease in overall volume and a change in shape throughout adulthood. This continuous bone remodeling process starts relatively early in life and is a primary factor in how the face transforms across the decades.
The Process of Skeletal Remodeling
Skeletal changes observed with age are governed by bone remodeling, a constant biological process occurring throughout the body. This involves two specialized cell types: osteoclasts, which break down old bone tissue, and osteoblasts, which create new bone tissue. In younger adulthood, the activity of these two cell types is tightly balanced, ensuring bone strength and maintenance.
As a person ages, this equilibrium shifts, leading to a net loss of bone mass in specific facial areas. The rate of bone formation by osteoblasts tends to decrease, while osteoclast activity may remain equal or increase in certain sites. This imbalance results in a predictable restructuring of the facial bones: some surfaces experience deposition while others undergo significant resorption, causing the facial skeleton to shrink in volume and reduce the supportive framework for the overlying soft tissue envelope.
Structural Changes in the Upper Facial Skeleton
The upper third of the face, including the orbits and forehead, undergoes notable dimensional changes with age. The bony eye sockets (orbits) generally become wider, longer, and larger in area over time in both men and women. This expansion is concentrated in specific areas, such as the superomedial and inferolateral orbital rims, which tend to recede.
The recession of the bony rims changes the contour and depth of the eye socket, making the opening larger and causing the eyeball to appear sunken. The glabellar region (brow bone) also shows a reduction in volume and projection. This loss of anterior support alters the angle and prominence of the brow ridge.
These changes can begin to appear earlier in women, sometimes between young and middle age. The widening of the orbital aperture and the retraction of the surrounding bone diminish the supportive capacity for the delicate tissues around the eye.
Changes in the Midface and Mandible
The midface, formed by the maxilla, experiences profound age-related skeletal changes, resulting in a loss of anterior projection. The maxilla, which supports the upper teeth and cheeks, undergoes significant resorption and thinning. This bone loss is particularly pronounced near the nose (the pyriform aperture) and in the cheek support area.
This recession causes the midface structure to flatten and move backward. This reduced projection is a factor in the apparent descent of the cheeks and the formation of folds, as the thinning maxilla reduces the platform holding overlying soft tissues forward.
The lower third of the face, centered on the mandible (jawbone), also undergoes measurable remodeling. The height of the mandibular ramus (the vertical part of the jawbone) decreases with age, reducing the overall vertical dimension of the lower face. The length of the entire jawbone also tends to decrease.
The angle of the jaw, where the body and ramus meet, tends to increase, becoming more obtuse. Bone resorption is frequently observed in the prejowl sulcus area of the mandible, the bone directly in front of jowl formation. This localized bone loss weakens the underlying support structure for the lower jawline.
How Skeletal Shifts Influence Visible Aging
Predictable bone resorption throughout the face has direct consequences for the appearance of the overlying soft tissues. When the bony framework shrinks, the skin, fat pads, and muscles have a reduced structure to drape over, causing an appearance of looseness or “sagging.” For instance, the widening of the orbital aperture contributes to a hollowed or sunken look around the eyes.
The recession of the orbital rims means fat pads within the eye socket are less constrained, which can lead to tear-trough deformity and prominent eye bags. In the midface, the backward and downward movement of the maxilla reduces foundational support for the cheeks. This loss of projection causes the skin and fat to descend, significantly deepening the nasolabial folds.
In the lower face, bone loss in the prejowl area creates a deficiency in the jawline contour. This lack of skeletal support allows the overlying soft tissue to collect and bulge forward, resulting in jowl formation. Ultimately, visible signs of aging—such as a less defined jawline or a flatter midface—are largely a secondary effect of the continuous remodeling and volume loss of the underlying facial skeleton.