Above, the facial scan of a younger female compared to an older female below. The angle of the jaw increases markedly with age, which results in a loss of definition of the lower border of the face. Jaw length decreases significantly in comparisons between the young and middle age groups. The decline in jaw height from the middle to old group was noteworthy. (Courtesy: University of Rochester)

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U. ROCHESTER (US)—It may take more than a skin-tightening facelift to restore a youthful look. Significant changes in facial bones—particularly the jaw bone—occur as people get older and contribute to an aging appearance.

Understanding this offers new insight into procedures that may successfully restore a youthful appearance, says Howard Langstein, professor and chief of plastic and reconstructive surgery at the University of Rochester Medical Center.

Reviewing a collection of 120 facial CT scans taken for other, unrelated medical reasons, plastic surgeons measured changes that occurred to facial bones over time.

The CT scans were divided equally by gender and age, 20 men and 20 women in each of three age groups: young (ages 20-36), middle (41 to 64), and old (65 and older).

Researchers used a computer program to measure the length, width, and angle of the mandible, or jaw bone, for each scan, and compare the results for each group. Details of the research appear in the Journal of Plastic and Reconstructive Surgery.

Using CT scans allowed for more accurate three-dimensional reconstruction and increased accuracy of measurements, disputing previous research that relied on traditional head X-rays and suggested that the jaw bone expands with age.

The angle of the jaw increases markedly with age, which results in a loss of definition of the lower border of the face. Jaw length decreases significantly in comparisons between the young and middle age groups. The decline in jaw height from the middle to old group was noteworthy.

“The jaw is the foundation of the lower face, and changes to it affect facial aesthetics,” explains Langstein.

“These measurements indicate a significant decline in the jaw’s volume as a person ages, and therefore less support of soft tissue of the lower face and neck.”

This loss of bony volume may contribute sagging facial skin, decreased chin projection, and loss of jaw-line definition. As jaw volume decreases, soft tissue of the lower face has less support, resulting in a softer, oval appearance to the lower face and sagging skin, which also affects the aging appearance of the neck.

“Physicians have long been taught that facial aging is caused by soft tissue descent and loss of elasticity,” Langstein says. “Though we have always known that bones change over time, until now, the extent to which it causes an aged appearance was not appreciated.”

“The future of facial cosmetic procedures to restore a youthful look may include methods to suspend soft tissue—such as chin and cheek implants—to rebuild the structure that time has worn away, in addition to lifting and reducing excess skin,” says Langstein’s colleague, Robert Shaw, a plastic surgery resident.

Researchers from Stanford and Harvard universities contributed to the study.

University of Rochester health news: www.urmc.rochester.edu/news/