Volume 94, No.1, January-February 2008



Cranium Changes

A cranium
Bettmann / CORBIS

There's a new wrinkle in the battle against looking old: Doctors have discovered that it's not gravity that's pulling your skin down—it may be your shifting bone structure.

While many think the Earth's gravitational pull is to blame for sagging facial features, researchers at Duke Medical Center have discovered that changes in the face's underlying bony structure may be the culprit. And those changes appear to occur more dramatically in women than in men.

"This paradigm shift may have big implications for cosmetic eye and facial surgery," says Michael Richard, assistant clinical professor of ophthalmology and an oculoplastic surgeon at the Duke Eye Center. Richard presented his research at the annual meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgeons this past fall.

"Our focus has always been on tightening and lifting the soft tissues, skin, and muscle in an attempt to cosmetically restore patients' youthful appearance. Based on this information, it might actually be better to restore the underlying bony framework of the face to its youthful proportions."

Since most bones in the body stop growing after puberty, experts assumed the human skull stopped growing then too. But using CT scans of 100 men and women, the researchers discovered that the bones in the human skull continue to grow as people age. The forehead moves forward while the cheek bones move backward. As the bones move, the overlying muscle and skin also move, subtly changing the shape of the face.

"The facial bones also appear to tilt forward as we get older, which causes them to lose support for the overlying soft tissues," Richard says. "That results in more sagging and drooping."

The problems from these aging changes extend beyond cosmetic concerns. Drooping tissues around the eyelids can lead to vision problems, dry eyes, and excessive tearing.
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