The aging process in the midface does not occur randomly. It follows a six-stage “domino effect,” beginning with the collapse of deep structures and gradually appearing on the skin surface. The stages are as follows:
- Stage 1. Bone Resorption: This process usually begins after the age of 40. The upper jawbone, orbital bones, and cheekbones gradually lose volume. As the structural foundation weakens, the soft tissues above lose support.
- Stage 2. Deep Fat Atrophy (SOOF, DMC): The deep fat compartments beneath the skin begin to shrink early due to the natural aging process. This causes hollowing under the eyes, loss of malar fullness, and creates the foundation for tear trough formation.
- Stage 3. Descent of Superficial Fat: As the deep fat layer shrinks, the superficial fat above loses its support structure. Gravity then pulls the superficial fat downward. This sagging causes tissue accumulation in the lower area, making the nasolabial folds deeper and extending the tear trough.
- Stage 4. Weakening of Ligaments and SMAS Laxity: The retaining “support cables” of the face, such as the zygomatic and orbital ligaments, become stretched and weakened. At the same time, the Superficial Musculoaponeurotic System (SMAS) becomes thinner and looser. The entire internal support framework weakens significantly. Skin and soft tissues continue to sag downward without sufficient resistance.
- Stage 5. Lengthening of the Lid-Cheek Junction and Tear Trough: The boundary between the lower eyelid and the cheek becomes elongated, forming a dark, hollow, and tired-looking depression beneath the eyes.
- Stage 6. Loss of Elastin in the Skin: Collagen and elastin levels decrease, causing the skin to lose its tight attachment to the muscles. Surface wrinkles and excess skin begin to appear. This is the final result of the aging process, not the original cause.
Comment on the post