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Demystifying Facial Ageing: What You Need to Know

Updated: Feb 7

In light of the recent panic (at least at the time of writing this article) surrounding the TikTok "aged" face filter - I thought I'd shed some light on the process of facial ageing, and how you can have a bit more control over what your ageing experience looks like.

Many clients I have spoken to over the years have felt mystified by the ageing process, and I believe that understanding it, makes us feel more comfortable with it.

I do want to preface this article with a reminder: ageing is a privilege - one that not everybody gets. To have the opportunity to age is a gift that we should all appreciate immensely. Simultaneously, there is also nothing wrong with analysing the facial changes that come with ageing and strategically mitigating those that we do not like, or perhaps want to delay.

You can appreciate the gift of ageing and still want to botox your forehead lines. The two sentiments can co-exist. As I always say to my clients, it's not about "fighting" the ageing process or trying to look 20 when you're 50 - it's about you looking like your best self. It's about the person in the mirror matching how you feel. It's about having a degree of control over your ageing experience, because you can.

Most importantly, it's about you having a healthy, functional skin for as long as possible - after all, you only get one and it hopefully has to last a long time!

Now I'll get to the point.

A common misconception is that facial ageing is limited to changes in the skin. I believe that this misconception is why often people are disappointed by their skincare - they misunderstand what it can and can't do.

The reality is that facial ageing is a process involving multiple layers of tissue including skin, muscle, bone, cartilage, and fat. We'll go through each, layer by layer. Starting with...

Skeletal Changes

The facial bones are the framework for our overlying soft tissues (skin, fat, muscle). These bones provide structure, support, and definition to the face - but bone is not static. It is living tissue and it does change as we age.

When I was a kid, I thought my skeleton was solid, and stayed the same throughout adulthood. I vividly remember learning in biology class that bone tissue is alive and constantly remodels - I was amazed!

Our skeleton is constantly breaking down and building back up for the entirety of the human lifespan. At any given time there are osteoclast cells breaking down old or damaged bone tissue, and osteoblast cells replacing the old cells with new healthy cells.

When we're young and growing, the rate of new cells being formed is greater than the rate of cell breakdown, resulting in a net increase in bone tissue (allowing us to grow).

We reach a point of balance when we're fully grown, where the rates of breakdown and formation should be equal (from around age 25 to 50). But as we age beyond this point, the rate of bone breakdown begins to outstrip the rate of bone formation - resulting in a gradual net decrease in the overall bone tissue. In some areas this means our bones literally shrink, and in others it just means they are less dense. This process, is called bone resorption.

What does this mean for the face?

Bone resorption does not happen evenly. Facial bone resorption tends to affect some areas more than others - primarily the orbital rim (aka, eye socket), the maxilla (midface area), and the mandible (jaw bone).

Bone resorption in these areas results in loss of structural support for the nose, eyes and jaw, all of which are key areas of facial ageing. In faces that already have genetically weak bone structure, the changes are more noticeable.

  • The eye socket expands as bone resorbs, resulting in a larger opening and creating under-eye hollows and giving the eyes a more sunken appearance. The shape of the eye socket changes too, with the outer lower corners appearing to "droop".

  • The cheekbones flatten down, and become less defined.

  • The jawbone recedes, and the jaw becomes less defined.

  • Lastly, the tip of the nose can drop, due to loss of support, and the nostrils may widen a little due to loss of bone underneath the nose.

Now, this might all sound a little depressing - but keep in mind, skeletal changes happen very slowly, and affect some people more obviously than others. I wanted to include this information because it is key to understanding certain aspects of facial ageing, and having realistic expectations for your face.

Can we do anything about this?

At this point in time, the best preventative measures we can take to mitigate bone resorption are to live a healthy lifestyle that supports bone health. That includes:

  • regular exercise

  • ensuring we have adequate intake of calcium AND vitamin D

  • avoiding smoking + vaping

  • avoiding alcohol or minimising intake (alcohol can have a negative effect on bone remodelling).

When bone resorption has already occurred to a noticeable degree - dermal filler (in moderation) can be a good option to restore support in areas of bone loss, as it has the ability to create volume.

At this point I want to heavily stress the importance of choosing the right injector.

Most of you will, at this point, have seen what bad filler looks like (it's hard to miss!), but remember - good injectables are undetectable. Vanessa McNamara is my recommendation - with over a decade of experience, a minimalist approach, and the ability to say no (she has turned away many clients from our clinic when she didn't feel what they asked for was necessary) - she is the definition of "safe hands".

The Muscle Factor(s)

Muscle affects facial ageing in a few different ways.

  1. Facial muscles atrophy (shrink) as we age, just like bones do; they become thinner and smaller, which contributes to loss of volume and structural support.

2. Repetitive facial movements (frowning, raising eyebrows, smiling, talking) over time results in dynamic wrinkles, AKA expression lines. This is a result of repeated muscle movements, combined with the skin losing elasticity and structural integrity (reducing its ability to "bounce back" and allowing resting lines/deep wrinkles to form.)

3. Our chin muscle (the mentalis) can become over-active as we age, causing dimpling, uneven texture, or a bumpy appearance of the chin.

The good news, is that muscle tissue is far more easily influenced than bone. We have the option of utilising injectable muscle relaxants (eg. B*tox) to treat or mitigate number 2, and 3.

The formation of expression lines can also be slowed by maintaining good skin health. I've seen clients before who have relied solely on injectables to keep lines at bay, but neglected the health of their skin - the resulting look is unnatural. When treating lines, the best approach is to treat skin health first, then incorporate injectables if/when necessary.

Similarly to mitigating bone resorption, one of the best things we can do to minimise facial muscle atrophy (factor 1) is to live a healthy lifestyle that supports our muscle tissue. A nutrient rich diet, plenty of protein, avoiding smoking, and of course avoiding alcohol.

Unlike bone, facial muscles can also be exercised, and they can be stretched, massaged, manipulated. There is definitely a case for regular facial massage for slowing facial ageing - a treatment modality that we will be bringing to Skin Ritual in late March.

A note on "preventative b*tox"

Many people have asked me if this is a real thing. Preventative b*tox, in my opinion, means treating lines when they are at the superficial stage, to prevent them from developing into deep wrinkles.

It does not mean, getting b*tox when you have no lines present. This would be a waste of time and money, you simply don't need to.

Facial Fat (pictured above)

Fat pads are areas of closely packed fat cells that lie beneath the skin in distinct pockets.

As well as being found on the face, they are also present in other parts of the body, providing support, and cushioning. For example, fat pads are responsible for the squishy areas under the balls of your feet and your heels.

Subcutaneous (under the skin) fat pads are an important part of our facial structure, and it's been suggested that losing facial fat is one of the biggest contributors to overall volume loss as we age.

But it's not just a case of losing facial fat as we age - the fat we retain also goes through repositioning: it gravitates downward.

We tend to lose fat around our eyes (above and below), our temples, our cheeks/mid-face, and around our mouth.

On the other hand we tend to gain fat in the lower face/jaw/neck, in part because existing superficial fat migrates downward, and in part because we deposit more fat there as we get older.

Lifestyle factors can influence these changes:

  • Avoiding extreme and fast weight loss. Too much fat loss in too short a space of time can accelerate the loss of facial fat pads.

  • Avoiding over-doing cardio - I know some people will hate to hear this, and as a HIIT fan myself, it was a hard pill to swallow. The term "runners face" describes individuals who frequently engage in intensive and long periods of cardiovascular exercise, and subsequently have accelerated the loss of their facial fat pads.

  • Avoiding over-use of deep laser treatments and RF (Radiofrequency) on the face, both of which can result in fat loss (this is why I am such an advocate for micro-needling and chemical peels!). Facial fat/volume loss after laser and radio-frequency treatments CAN occur, and these treatments should be done in moderation and on the right candidate.

Once again, strategically placed dermal filler can offset some of the visual effects of facial fat loss, but they must be placed skilfully to achieve a natural result.

And finally, the skin.

The layer of facial ageing we have the best access to. Unlike bone, muscle, and fat - with skin, we can use topicals (serums, creams) to deliver nutrients and influence skin health and function.

There are two main layers of the skin: the epidermis, and the dermis. Unique processes occur in each layer that contribute to overall skin ageing.

In The Dermis

This is the deeper layer of the skin. This layer contains fibroblast cells which produce collagen, elastin, and hyaluronic acid. It also contains the blood supply of the skin.

Collagen + Elastin Loss

Just like bone, collagen and elastin are constantly being created and broken down. Fibroblast cells create, and MMPs (enzymes) break down.

As we age, our fibroblast cells become less active, and our MMPs become more active, resulting in a net decline of collagen and elastin.

On top of that, UV rays break down collagen which causes us to lose even more.

Finally, glycation - a process where excess sugar in the bloodstream binds to collagen and elastin, making it brittle - damages our collagen and majorly reduces elasticity and structural integrity of the skin.

The cumulative effect of all of this is a gradual decline in elasticity, tightness/firmness, and structural integrity of the skin. It can also result in the appearance of larger pores as the loss of support around pores allows them to "splay" open, and of course, the development of lines and wrinkles.

The good news? There is a LOT we can do about it:

  1. Use topical retinoids (eg. retinol serum) to stimulate fibroblast cells

  2. Use topical vitamin C to support collagen production

  3. Use topical antioxidants to mitigate collagen and elastin breakdown

  4. Protect our skin from UV rays to prevent damaging these precious proteins (sunscreen, sun protective clothing, sun avoidance)

  5. Reduce sugar and alcohol intake to protect our collagen and elastin from glycation

The Dermal-Epidermal Junction

The epidermis is avascular, meaning it has no blood vessels of its own. Normally, blood is what transports nutrients to various areas of the body, so for an area with no blood flow - there needs to be another way to get those nutrients. Enter, the dermal-epidermal junction.

This junction is what joins the epidermis and dermis. The junction facilitates the transfer of nutrients from the dermis (which does have a blood supply) to the epidermis. 

As we age, the DEJ (dermal-epidermal junction) becomes weaker and the nutrient transfer does not happen as it should. As a result, the epidermis is starved of nutrients and its health and appearance will deteriorate.

What we can do

Topical vitamin A (eg retinol), maintains the healthy function of the DEJ, thus ensuring good nutrient transfer to the epidermis. 

Microneedling restores structural integrity to the DEJ by restoring its structure through induced tissue remodelling.

UV damages the DEJ, so daily use of sunscreen (and sun avoidance within reason, eg. avoiding significant exposure during peak times) is crucial to prevent DEJ damage.

The Epidermis

Just like every other layer - you guessed it, the cells in the epidermis are constantly renewing. New cells form in the basal layer, and old cells fall off the surface layer of the skin (the stratum corneum).

This process of cell renewal is also known as cell turnover. Ideally, the cell turnover rate should be roughly 28 days - but as we age, it slows down to 30, 40, 50, even 60 days. This slowdown means old cells are sitting in the skin accumulating damage for a lot longer - and it shows.

The result is duller, more textured skin.

We can override this and speed up our cell turnover with topical vitamin A, which stimulates cell turnover.

UV exposure can also trigger our stratum corneum (outer layer) to build up even more, in an attempt to protect the skin against UV damage (this is why people who have spent their lives in the sun develop a "leathery" skin appearance). Once again, the answer here is daily sun protection.

Pigmentation is in my opinion, a topic for an entire article of its own, so I won't go too far into detail - but the solution is once again, sun protection, vitamin A, and topical nutrients like vitamin B, C, and other antioxidants.

In Conclusion

First off - congratulations for making it this far. At this point, you should have a much greater understanding of the ageing process of your skin, and how to influence that process.

Secondly - believe it or not, this is still an abbreviated version. There is more detail and nuance to the ageing process than this, but this article covers the most important points and gives a thorough overview.

More than ever, it's clear that following a holistically healthy lifestyle will result in the best possible facial ageing. Topical care for the skin, yes absolutely. But holistic care for the entire body too.

We should care as much about our brain health as we do about our wrinkles.

We should care as much about our metabolic health, our joint health, our heart health - as we do about pigmentation, laxity, and under-eye bags.

Let us focus on supporting our entire body for a positive ageing experience. Care for the whole body and you will see the benefits in your face - I promise.

Any questions? Reach out, I'd be happy to chat!

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