Sag & Bone- What is really behind an aging face?


For women nearing the age of 40, a distressing phenomenon begins to appear in the mirror. We start to notice the dreaded jowls, sagging cheeks and undereye “bags”. Reaching for the face cream won’t help what is in front of you. Looking behind the skin’s surface will explain why. Facial aging is due to changes in several types of tissue, including skin, fat, and bone.

Aging skin is thinner, drier, less elastic, produces less collagen and is more likely to wrinkle or sag.

Skin Aging

Fat isn’t something we typically value, but when it comes to a youthful face, fat provides the stuffing for the skin envelope.  As aging progresses, fat not only begins to atrophy, it shifts and redistributes to other parts of the face.


Fat is represented by the yellow areas in the diagram above and shows the loss of fat from the temples, around the eyes and the cheeks.  It’s easy to see that without the supporting fat, the eyes become hollow, the nasolabial folds deepen and the cheeks sag forming jowls.

structure changes through bone expansion and resorption. Resorption leads to bone loss. The diagram shows flattening of the cheek bones and recession of the chin.

Because of changes in all three, skin, bone and fat, no one treatment, procedure or cream can rejuvenate all three. For aging skin, a rejuvenating fractional laser or deep chemical peel can trigger collagen production to improve the skin’s texture and elasticity.   Lost facial fat can be restored with fat grafting or the injection of biostimulating products such as Sculptra or Bellafill. Bone loss cannot be reversed, but plastic surgery offers cheek and chin implants to help balance lost projection

Board certified plastic surgeon Gilbert Lee, M.D. of Changes Plastic Surgery & Spa in San Diego, CA. is an expert in treating loss of fat, bone, and sagging skin.  Schedule a consultation to learn how you can get ahead of the aging game.

Copyright 2014 Jill Darrah for Changes Plastic Surgery & Spa