Most battles against age are waged directly on sagging skin. But new research suggests we are not cutting deep enough.
Cosmetic surgeons are now saying that bone implants might be the new face-lift.
"We used to think of the bones as static, but now we know they are constantly changing," said senior researcher Dr. Howard Langstein at the University of Rochester in New York. And as we get older, these changes not only curve backs and diminish stature. They also age the face, the researchers found.
"It is very well-known that skin and (facial) fat atrophy as we age," said lead researcher Dr. Robert Shaw, Jr., also at the University of Rochester. But in case that wasn't depressing enough, the researchers found that jaw, cheek and eye-socket bones are also worn down by the march of time.
The loss of this "scaffolding" results in the familiar curses of old age, Shaw said, such as upper eyelid droop, plummeting cheeks and jowls that sway in the breeze.
The scalpel of youth first fixated on stretching out wrinkles.
"But patients would come back from a traditional face-lift, and we would look at pictures of them when they were young and they didn't look like them," Shaw said. "We needed to look at what else was going on with aging," he said.
Turns out, "it is not just that your skin is getting less elastic with age, you are also getting decreased support from the bone," Shaw said. This results in less face volume overall, something that is not accounted for by traditional face-lifts that simply stretch the skin tight.
In the study, 60 men and 60 women were divided into three equal groups: young (20-40), middle (41-64) and advanced age (65 and older). Using three-dimensional computed tomography (CT) scans, they found older people had receded chins and short jaws in comparison to younger people. The study was published in the Journal of Plastic and Reconstructive Surgery in January.
A follow-up study, also of 120 people, showed that cheekbones and the upper-rim of the eye-socket also sink in as one ages, leaving cheeks to sag and the brow to droop. These findings were presented at a conference for the American Society of Plastic Surgeons last week.
So what can you do other than drink your milk and hope for the best?
One weapon against facial volume loss is already in popular use: fat.
Fat, in addition to plentiful bone, is a key ingredient to a youthful face. It is the giver of pinch-able cheeks and baby-smooth skin. In hopes of imitation, popular cosmetic procedures take fat from a person's gut, thighs or hips and strategically inject it into the face.
But going forward, "there will be more attention paid to the skeleton," said Langstein.
"We are not saying that traditional face-lifts are obsolete," he continued. "But in order for us to give a patient the best bang for the buck, we should also think about augmenting bones."
Jaw, chin and cheek implant surgeries are not complicated, Langstein said. "They require a week or two of recovery time and are relatively painless," he said.
Even so there are risks involved. Most complications are caused by an implant moving out of place, making a second surgery necessary. Infection and numbness can also occur.
But to erase all of Father Time's handiwork, implants alone are not enough. Fat injections and skin stretching will likely be necessary as well, the researchers said.
Or you can create a 21-year-old avatar and save yourself the cosmetic surgery.