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Alfertshofer, Michael G. and Cotofana, Sebastian (2021): Das alternde Gesicht – Eine anatomische Übersicht. In: Journal für Asthetische Chirurgie, Vol. 14, No. 2: pp. 62-67

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Background Facial aging signs are the result of a plethora of age-related physiological changes of various tissues in the faces, such as skin, bones, ligaments, fatty tissue and muscles. Objective To give an anatomical overview of age-related changes of facial tissues. Material and methods In this overview article the current findings of clinical, imaging and anatomic descriptive studies are summarized. The focus of this article lies on the tissues below the skin: bones, ligaments, fatty tissue and muscles. Results The physiological changes of the tissues vary greatly depending on the facial location. In the midface for example, an increased bone reduction in the maxilla region has been found while an increase of frontal bone thickness in the lower third of the forehead could be observed. According to current studies ligaments are not affected by age-related changes. The course of facial ligaments is only affected by the age-related changes of their bony fundament. Also, the fatty tissue in the face shows different properties in the aging face depending on the location: The superficial fatty tissue (layer II) and the deep fatty tissue (layer IV) are affected differently by aging. A decreased contractility of facial muscles has been observed in the aging face. Conclusion The age-related physiological changes in the face are manifold and different in every individual. Safe and effective rejuvenation procedures in the face can only be performed with a thorough understanding of the local tissue-specific changes and the interaction with surrounding tissue layers and adjacent anatomic structures.

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