For a long time, the main way to slow down the aging of the face has been face lifts and other wrinkle reduction techniques, but a new study in the United States has found that to rejuvenate the face, it is not enough to just tighten the loose skin. Doctors at the University of Rochester Medical Center in the United States have pointed out through their research that facial bones, especially the jawbone, undergo significant changes as we age and that this can lead to the face taking on an aged appearance. This research has been presented at the annual meeting of the American Society of Plastic Surgeons (ASAPS) and in the journal Plastic and Reconstructive Surgery. The study predicts that future facial rejuvenation techniques will be a two-step process: first, the restoration of the subcutaneous structures of the face, and second, the tightening of the facial skin. For the study, plastic surgeons collected 120 CT scans of the face and measured changes in the facial bones in the scans. Based on age and gender, the plastic surgeons divided the 120 scans into three equal groups: young (20-36 years old); middle-aged (41-64 years old); and old (65 years old or older), with each group containing 20 men and 20 women. Afterwards, a computer program was used to measure the length, width, and angle of the mandible in each CT scan and to compare the measurements in each group. Previous studies on this topic have also concluded that the jaw angle widens with age, but have relied on traditional head X-rays, making the findings controversial. This study, however, used CT scans to improve the accuracy of the measurements with a higher precision of 3D reconstruction. The measurements showed that the angle of the jaw angle becomes significantly larger with age, resulting in a gradual loss of the original clear contour of the lower edge of the face. The difference in jaw length between the younger and middle-aged groups was not significant, whereas the change in jaw height from the middle-aged to the older group was. Professor Howard N. Langstein, Chief of Plastic and Reconstructive Surgery at the University of Rochester Medical Center, said, “The jaw is the foundation of the lower face, and changes in the jaw can have a direct impact on facial aesthetics. Our measurements show that as a person ages, their jaw volume decreases significantly, and as a result the soft tissues of the face and neck receive progressively less support.” The loss of bone volume causes the facial skin to sag and the chin protuberance to shrink, causing the jawline to fade in profile. As the volume of the jawbone shrinks, the force supporting the soft tissues of the lower face diminishes, causing the lower face to become softer, oval in appearance, and the skin to become loose, which can also aggravate the aging of the neck. Dr. Langstein states, “Plastic surgeons have long believed that facial aging is caused by sagging of the soft tissues as well as decreased skin elasticity. While we’ve always known that bones change over time, we didn’t realize until now that changes in bones can, in part, contribute to facial aging as well.” A study conducted by Dr. Langstein and plastic surgery resident Dr. Robert Shaw confirmed that the facial skeleton is constantly undergoing changes to it from external forces. Understanding that the facial skeleton changes predictably with age allows plastic surgeons to develop new techniques that can help people successfully regain a youthful appearance. In conclusion, Dr. Shaw believes, “The future of facial plastic surgery to help people rejuvenate their appearance should look something like this – in addition to lifting and removing excess skin, soft tissue aging should be slowed with chin and cheek prostheses to rebuild facial structures that have been damaged by the years. “