Sagging Face: Bones to Blame?

Nov. 9, 2007 -- When faces sag with age, there may be an architectural reason for it -- and possibly an architectural fix, too.

It's all about the bones, according to Michael Richard, MD, and Julie Woodward, MD, of Duke University Medical Center.

They studied head scans of 100 patients treated at Duke University Medical Center over the past three years.

The patients fell into four groups:

• 25 women aged 18-30
• 25 men aged 18-30
• 25 women aged 55-65
• 25 men aged 55-65

Foreheads were more prominent and cheekbones were less prominent in the older patients.

"The facial bones also appear to tilt forward as we get older, which causes them to lose support for the overlying soft tissues," Richard says in a news release. "That results in more sagging and drooping."

Those changes appear to be more dramatic in women, the study shows.

Richard suggests that cosmetic surgery to lift sagging skin may be more about the face's bony framework than the skin itself.

"Our focus has always been on tightening and lifting the soft tissues, skin, and muscle in an attempt to cosmetically restore patients' youthful appearance. ... It might actually be better to restore the underlying bony framework of the face to its youthful proportions," says Richard.

But it's not just about looks.

"One of the big risks of facial surgery is the potential for hitting the facial nerve, which could cause paralysis," says Richard. "If we can move the focus to the bone surface, away from that nerve, we may create an even safer, less extensive surgical procedure than the ones we perform today."

Richard presented the findings today in New Orleans at the American Society of Ophthalmic Plastic and Reconstructive Surgeons' fall scientific symposium.