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Beauty Is More Than Skin Deep

Why a face-lift alone won’t work

Everyone knows that skin sags with age, which is why surgical procedures that stretch our faces to make us look younger constitute a multimillion-dollar industry. But a new study supports what anyone who has seen a bad Hollywood face-lift can already attest to: Stretching the skin alone can’t restore the fresh bloom of youth. It’s not just the skin that sags with age, but the skeleton, too.

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Greater understanding of how the skeleton ages may offer more than new and improved age-reducing beauty enhancements. It also may provide insight into maintaining better bone health and even expand the field of forensic anthropology.

A group of plastic surgeons at the University of Rochester studied three-dimensional CT scans of 60 patients of varying ages to examine potential shifts in facial skeletal structure. They discovered that as people age, the cheekbones around the eye socket descend and the jawbone becomes thinner, creating the sunken-eyed, slack-jawed appearance characteristic of aging.

“Facial bones act like a scaffolding for your skin,” explains Robert Shaw Jr., M.D., lead author of a study published in the journal Plastic and Reconstructive Surgery. “If you lose that support, the way your skin looks will change,” no matter how tightly you pull it.

For the skeleton, unlike skin, gravity isn’t the culprit. Although we may think of bone as a solid material, it’s actually “a living dynamic tissue that responds to pull,” according to Howard Langstein, M.D., another of the study’s coauthors. “When you chew, you’re exerting a little bit of force on that bone tissue. As people get older and chew less, they put less force on the jaw, which keeps it healthy and strong.”

Does that mean that chewing a pack of gum each day will keep our jaws looking full and young? It might help, but there’s still an uphill genetic battle in the aging process.

“It’s possible that there is a preprogrammed dissolving factor in certain bones,” says Langstein. “There are cells that make bone and cells that digest bone. It could be genetically determined that they have an end date, but we don’t know.”

If soft food and genetic countdowns are stacked against looking young, there’s always surgery. Implants such as collagen-like materials can be injected for temporary restructuring of the facial scaffolding.

More permanent solutions include fat grafting or even screwing bits of bone together to rebuild the structure. With any kind of implant, however, there is a risk of infection.

For Janet Monge, acting curator of physical anthropology at the University of Pennsylvania Museum, the study offers new insight into forensic anthropology even as it highlights our culture’s attitudes toward aging.

Working with a collection of skeletons dating from 12,000 years ago to historic times, Monge says that it’s difficult to pinpoint specific ages of each skeleton. “We wind up lumping them into really broad categories,” she says. The ability to link facial characteristics to specific ages “should be really useful for forensic anthropology.”

Monge, who teaches classes in death and aging from an anthropological perspective, underscores that bone tissue is dynamic, particularly at the beginning and end of the life cycle. Bone development is a change that happens rapidly in youth, followed by a middle period of relative stability and then osteoporosis in older age. “Although we treat osteoporosis as a disease, it’s actually a normal, degenerative change, just like growth,” she says.

Chris Haines is a writer living in New York.

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