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Books/Facial Aesthetics: The Anatomy of Natural Results/Facial Skeleton and Bony Aging: The Invisible Erosion
Chapter 039 min read

Facial Skeleton and Bony Aging: The Invisible Erosion

The face is not just soft tissues; the underlying skeleton changes shape over time. This section explains the aging of facial bones and why this is the basis for filler selection.

Main ideas in this chapter

  • The facial skeleton remodels with age; some areas grow, others resorb.
  • The orbital cavity widens, the maxilla and mandible recede — soft tissues lose support.
  • If there is bone loss, surface filling alone is insufficient; "deep structural restoration" is required.

Do bones age?

The belief that "bone tissue is static" is false. Facial bones are constantly remodeling; osteoclast (bone-resorbing) and osteoblast (bone-forming) cells are active throughout life. In youth, the balance favors formation; with aging, the destructive aspect becomes dominant. Especially the orbital (eye socket) rim, maxillary bone, and mandibular angle undergo significant changes.

Orbital rim: the skeletal frame of the eye

The orbital rim (eye socket edge) widens with age — significant bone loss occurs, especially at the inferolateral (outer lower) corner. This is the skeletal dimension of under-eye hollowing. Superficial filler alone is not enough; it needs to be supported at the bone level with deep injection (supraperiosteal).

Maxilla and piriform angle

The maxilla (upper jaw bone) recedes with age; the nasal base and upper lip lose support. The piriform angle (side edges of the nostrils) sharpens. This is the main reason for the impression of "upper lip disappearance" and "sagging lip corners."

Mandible: jawline

The mandibular angle (gonial angle) is distinct in youth; with aging, in addition to bone loss, soft tissue sagging also occurs, and the jawline "blurs." Jawline filler is done with a firm filler placed on the bone to correct this two-dimensional loss.

“Aging in the face is written on the skeleton, not the skin. Re-weaving the skeleton instead of lifting the skin is the key to a natural outcome.”

— Dr. Hamza Gemici