Introduction
The face is a symbol of a person’s identity as well as an integral component of social communication. Ageing of the face is visible and of significant cosmetic importance so alterations in the facial appearance has been extensively studied. Although facial changes from ageing are specific to each individual as a manifestation of genetics, there is no denying that sooner or later chronological age will begin to show its ravages on the face. The changes occur slowly and are affected significantly by factors, such as ethnicity, health, gender and the lifestyle of the individual.
Gravity is not the sole determinant of the aging face. It has been demonstrated that volume loss, including that of soft tissue and bone, is equally important in the pathogenesis of the stigmata of aging1–2. Facial anatomy is composed of three general elements: skin, soft tissue, and the underlying skeletal support that provides the basic shape of the face. All these elements undergo a spectrum of changes with age resulting in the sad old look.
Facial aging is a dynamic process involving the aging of soft tissue and bony structures. Epidermal thinning and the decrease in collagen cause skin to lose its elasticity. Loss of subcutaneous fat, coupled with gravity and muscle pull, leads to wrinkling and the formation of dynamic lines. The bones of the face undergo contraction and loss of bony volume and projection thus contributing to the aged appearance3–5. This review addresses the different changes in facial anatomy with some reference to variations by ethnicities.
