Cosmetic Dermatology
What surprising thing your face loses with aging: Bone
In just five minutes, we witness aging in rapid speed. But, how can we better understand the facial changes that accompany time’s advance?
At first blush we notice the skin. Indeed, as we age, our skin thins and loses its elasticity. It becomes a stretched out rubber band and can’t compensate when deeper structures begin to deflate. This leads to fine lines and texture changes. And then fat. It too begins to diminish, especially in the temples, forehead, and over the cheekbones. Gravity pulls these thinning fat pads, and we start to notice more prominent smile lines, jowls, and an early double chin. But even more impressive than these changes in skin and fat is the amount of bone loss that accompanies aging. Yes, bone loss.
Over the age of 35, the number of bone regenerating cells in the face decreases. Gradually, the bone around our eyes widens, leading to eye hollows and flattened cheeks. Then, the bones of the central face and jaw degrade while rotating back and downwards. Together, these changes result in a diminished bone scaffold on which our fat and skin sit. Our tissues become too large for their underlying bones, and wrinkles and folds become more evident. Over time, our faces begin to resemble the proportions of a baby’s face. Have you ever wondered why babies have hanging cheeks and jowls? It’s because they have too much skin and fat relative to their facial bones. Over time, we grow into these soft tissues and proportions idealize in our 20s. Then, as we begin to lose bone in the next decade, the smile lines deepen and jowls gradually return.
Bone and soft tissue proportions change as we age. The distance from the mouth to nose and nose to eyes are approximately equal in a baby. As bone growth continues in childhood, we grow into our facial tissues and the distance from our mouths to nose is about ½ the distance from our nose to eyes. This proportion is a beauty “ideal.” Then, as we continue to age and lose bone faster than we lose skin and fat, our proportions return to that when we were babies: the distance from the mouth to nose and nose to eyes are approximately equal. Jowls and hanging skin return.
So how do we address facial bone loss?
Optimizing bone health is key. Calcium, vitamin D, exercise, and even dental hygiene to keep the jawbone healthy are certainly important. But, we can also place facial fillers along the bone to recapitulate a more youthful skeleton.
Radiesse is one such filler that can be injected deeply along the bone. Radiesse is made of a calcium-type substance similar to that found in bone and teeth. Because of this “biocompatibility,” when injected under the skin, it doesn’t cause allergic reactions. If placed just above the cheekbone or jawbone, it gives these areas more definition in a natural way. Radiesse typically lasts 12-18 months and gradually resorbs.
Sculptra is another skin volumizer that can be injected along the bone to lift the cheeks, reflate sunken temples, and recreate a more defined jaw line. Sculptra is made out of a slowly dissolving substance derived from lactic acid. Like Radiesse, because lactic acid is a natural substance in our bodies, it integrates beneath the skin without causing allergic reactions. Unlike some fillers that immediately “fill” lines and folds, Sculptra more gradually re-volumizes the areas where it is injected. Sculptra particles push on cells called fibroblasts, encouraging them to create collagen. Collagen is the major support protein in our skin that gives our faces structure and firmness. So, as collagen builds over 4-6 weeks after injections, the targeted areas are re-volumized very naturally.
But while both Sculptra and to some extent Radiesse engage fibroblasts, stimulating them to create more collagen, collagen doesn’t have the lasting power of bone. At most, results persist for up to 2 years before collagen again breaks down. However, new research is suggesting that fillers, if injected with just the right cocktail of cellular signals, might be able to encourage bone growth themselves1. To date, outside of surgically placed permanent implants, we don’t have an exact way to make our bodies re-grow lost facial bone. If we learn how to do this, we may have a much longer-lasting way to rejuvenate the face without surgery. Stay tuned!
- Raghavendran HR et al. Synergistic interaction of platelet derived growth factor (PDGF) with the surface of PLLA/Col/HA and PLLA/HA scaffolds produces rapid osteogenic differentiation.Colloids Surf B Biointerfaces. 2016 Mar 1;139:68-78.
