Facial Aging

There are few certain things in life, and aging is one of them.  All things age and although some say that “age is only important in wine and cheese,” we know better.  Humans have been searching for the fountain of youth since recorded history and mankind has gone through some pretty crazy phases in the name of trying to stay young.

There is no doubt that your average man or woman wants to look as young as they can for their age.

Facial Aging

We now live in a time when the Baby Boomers are in their 5th and 6th decades and these were the people who thought themselves immortal!  We are lucky that we live in a time of technological advancements as even 15 years ago there was not Botox, Laser, endoscopic brow lift, or predictable long lasting fillers.

Today, it is easier than ever to look younger.

How does the face and neck age?

This is a very complex question to answer and volumes have been written about the subject. To look at things in a simplified manner, we will break down the anatomy to:



This is pretty simple.  If you are lucky enough to have hair [poor Dr. Niamtu :(] it will become dry, thin, brittle and usually grey.  We are pretty genetically programmed to what will happen to our hair, but hair loss and recession is a problem for men and women.  Using drugs like Propecia and Rogaine can help some people where as others require hair micrografts. The skull also shrinks as we age and leads to excess and droopy skin which is part of upper facial aging.

Forehead & Brow

Forehead & Brow

Aging changes in this region include ptotic (drooping) brows with excess skin on the top and side of the upper lids as well as frown lines and horizontal forehead wrinkles.  The bridge of the nose becomes thickened and the excess forehead and lid skin may obscure vision.  Brow and forehead lifting and neuromodulators such as Botox and Dysport and injectable fillers are used to treat the brow and forehead.

Upper Eyelids

Upper Eyelids

The upper lids begin to change in the mid third decade and this is manifested by excess and droopy upper eyelid skin with protruding fat deposits.  The upper lid skin can obstruct vision and the excess skin, muscle and fat can make the eyes look smaller.

Upper eyelid blepharoplasty(eyelid tuck) is one of the most common cosmetic facial surgery procedures to rejuvenate the upper lids.

Lower Eyelids

Lower Eyelids

The lower eyelids also make patients look older and tired.  The fat that normally cushions the eyeball begins to protrude with age and produces pouches on the lower eyelid.  These tend to look worse in the morning or when we are tired.  These pouches also produce a shadow under the lower lid which contributes to “dark circles”.  The lower eyelid skin is very thin and becomes crinkly and wrinkled.  Sun damage and pigment changes also contribute to the dark circles of aging. Treatment of lower eyelid aging involves lower eyelid blepharoplasty where the excess fat is reduced through a hidden incisions inside the lower lid.  The lower lid skin wrinkling is usually addressed with laser resurfacing, chemical peel or surgical excision.  Eyelid surgery takes about 15 minutes per lid and the recovery is about one week.



Of all areas, the midface is one of the largest contributors to facial aging.  The youthful midface is all about volume and plumpness.  Young people have full and volumized midfaces and this is one reason they look young.  In youth, we have the proper amount of fat in the correct places.  As we age, we lose fat in the cheeks and gain it in the jowls.  This loss of midfacial volume produces an aged, gaunt and hollow midface because the cheeks become the jowls!  So as we age, you can say we go from a grape to a raisin.


Volume loss, changes in the bone and muscle and skin damage catch up to all of us. Volume loss can be easily illustrated by examining the family around you.  This picture shows my 8 year old son, a 56 year old Dr. Joe and Joe Niamtu, Jr. at 83.


When we are young, our midface is naturally volumized and our lower face and neck are tight.  A youthful facial outline looks like an upside down egg.  With natural aging changes, we lose the midface volume and our lower face and neck becomes full.  This produces a facial outline that resembles a right side up egg. Some may say egg foo  young and egg foo old! Midfacial aging and volume loss is treated with cheek implants, injectable fillers, fat transfer and lifting procedures.
This patient was treated with mini facelift, upper eyelid surgery and cheek implants.  Although all the procedures contributed to her rejuvenation, the cheek implants made the most dramatic impact as the restoration of midfacial volume is consistent with youth.
Lips & Smile Lines

Lips & Smile Lines

The lips also undergo significant aging changes from youth to senior.  These changes include atrophy of the skin, mucosa, fat, muscle and glands.  The natural loss of tooth structure also affects the form of the lips.  Younger females have plump lips with an S- curve from the bottom of the nose to the teeth.  In addition, youthful lips are shorter than older lips. This picture shows the lips of a 25 year old and a 65 year old.  Note that the youthful lips are curved, plump and short while the older patients upper lip is elongated and has lost its volume and natural curves.

The older lip also develops vertical lipstick lines and the corners of the mouth become down turned.Treatment of the aging lips includes injectable fillers , Botox and Dysport, laser skin resurfacing and lip implants. The smile lines are called nasolabial folds and run from the nostrils to the side of the mouth.  Injectable fillers can plump deep smile lines and take off years in several minutes.

Lower Face & Neck

The Lower Face & Neck

Although all the above changes make us look older, there is nothing that makes us look like grandparents more than lower facial aging changes Sagging muscles, fat, and sun damaged skin produce bulges at the side of the jawline called jowls.

The same changes occur under the chin and on the neck.  The deep support system and skin sag and become excess which produces the vertical neck bands and “turkey gobbler” wattle that can extend from the jaw to the collar bone. Although the media  hypes “miracle” devices and surgeries to reverse jowl and neck skin excess, nothing is more natural, predictable and longer lasting than contemporary facelift surgery.  Remember, if it sounds too good to be true it probably is.  Contemporary facelift surgeons can increase results and decrease recovery, but two weeks of recovery is not too much to ask for reversing a half century of aging.

The Skin

The skin is the largest organ in the body and is our wrapping paper.  Although we cannot control many aging changes, we do have a lot of input as to how our skin will age.  Sun and wind damage, smoking, excessive drinking and heredity can prematurely age the skin. Skin aging is manifested by wrinkling, drooping, and pigmentation changes.  Nothing can make us look older before our time than sun damaged skin.

By using sunscreens, sun sense, Retin-A and bleaching creams we can reverse a lot of sun damage and prevent new damage from occurring.  Lifetime skin care is the basis of all cosmetic rejuvenation.  This image shows a patient photographed under ultraviolet light to show the amount of sun damage hidden beneath the skin.  The patient is shown in the right hand picture after laser skin resurfacing.  Chemical peel and laser resurfacing can reverse decades of skin aging and give the patient a chance to start all over again.  Second time around most patients take much better care of their skin!

Putting it all together

Once you understand what happens to these areas, it is easy to put it all together.  In order to plan on how to look younger, you must first understand how we age.  Remember, aging is not a bad thing, it means you are still alive.  Even the rich and famous can’t put off the effects of aging!  You can, however, age gracefully.

Even Barbie has matured and is a bit full figured.

Now that you have a basic understanding of some of the more common aging changes, Dr. Niamtu invites you to browse the various pages on our site to learn more about face and neck aging changes.  Since Dr. Niamtu writes his own web page and only uses pictures of his actual patients, he feels that our site is among the most educational web sites on cosmetic facial surgery.

We invite you to: