The changes of aging in the face are predictable enough to allow carnival entertainers to accurately guess your age. The first signs occur by age 30. Early skin creases appear around the eyes. The muscles pull on the overlying skin and crinkle it. The wrinkles form at right angles to the direction of the muscle pull and are actually stress fractures of the dermis. Plastic surgeons call these "dynamic wrinkles." They are different from the "static wrinkles" caused by weathering of the skin. The distinction between the two is important, since dynamic wrinkles return rapidly after treatment unless the underlying muscle is paralyzed or removed. Static wrinkles, on the other hand, can be treated without regard for underlying muscle.
The nasolabial folds begin to deepen by the late 30s, causing considerable dismay. By the 40s, other wrinkles appear on the face. Eyelid skin begins to droop and fat protrudes from the lids. The "tear trough" appears as the cheek fat heads south. Fat often begins to collect under the chin. By the 50s, sun damage has caused splotchy brown pigmentation to collect as wrinkles spread to the full face and begin to deepen. Excess skin in the neck invites remarks such as the "turkey gobbler," and the jowls rear their ugly heads. The eyebrows head south along with the earlobes. The tip of the nose and the ears increase in size, since cartilage can continue to grow throughout adulthood. By the 80s, the soft tissue of the face has significantly drooped, giving the elderly a skeleton-like appearance.
Dr. Scott Bartlett, a plastic surgeon at the University of Pennsylvania, has observed that while the height of the face decreases with age, the width increases. But unless the teeth fall out, the face does not shorten. In people who have lost their teeth, dentures and dental implants preserve the height of the face.
More Answers from Arthur Perry, MD