What are the key markers of aging?

Plastic surgeon Dr. Bryce Cowan explains the two primary processes that affect facial aging simultaneously–volume loss, and malposition. Dynamic wrinkles, which are “expression wrinkles” that occur when we make faces, slowly become fixed in place. Facial fat and volume is lost in the cheeks and temples commonly at a certain age. At the same time, it isn’t just the fats, but the support structures like the ligaments that hold the fats in the appropriate positions that also undergo change. As these support structure deteriorate, the fat pads change position, out of their original youthful placement, and this is why the overall appearance of the face changes. At the level of the skin, the protein composition also changes, elastin also breaks down which causes the skin to lose elasticity and tensile strength, and the dermis layer of the skin also becomes thinner with age.

Environmental factors like smoking and sun exposure can also accelerate this process, particularly the loss of elastin, causing wrinkling and loosening of the skin at an earlier age. Even the underlying facial skeleton, the bones, actually also change, becoming resorbed and therefore smaller over time to a certain extent.

So there are many many factors and changes that occur simultaneously. Aging is a continuous and complex process.

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How does Aging of the Face Manifest Itself?

In this video interview format series plastic surgeon Dr. Bryce Cowan answers questions related to how the face ages, and whether these changes can be prevented or reversed.