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Clues To Wrinkles May Be Found In Facial Bone Structure

Published November 9, 2007 | Updated January 20, 2016

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Duke Health News919-660-1306

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

While many thought the Earth's gravitational pull was to
blame for sagging facial features, researchers at Duke
University Medical Center have discovered 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," explains Michael Richard, MD, an
oculoplastic surgeon at the Duke Eye Center, who presented
his research at the annual meeting of the American Society of
Ophthalmic Plastic and Reconstructive Surgeons in New Orleans
today.

"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 growth plates found in most of the body's bones stop
growing after puberty, experts assumed the human skull stopped
growing then too. However, the bones that comprise the human
skull have no growth plates.

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
moves as well and that subtly changes the shape of the face.
"The facial bones also appear to tilt forward as we get older,"
explains Richard, "which causes them to lose support for the
overlying soft tissues. 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.

Richard and colleague Julie Woodward, MD, Duke's head of
oculoplastic and reconstructive surgery, also determined that
women experience more rapid bone changes then men. That, says
Richard, opens new areas of research, including the role of
menopause in facial bone growth, and whether drugs commonly
used for osteoporosis may affect the aging changes seen in the
facial skeleton.

Just as important are the implications their research may
hold for the future of cosmetic surgery. "One of the big risks
of facial surgery is the potential for hitting the facial
nerve," explains Richard, "which could cause paralysis."
Doctors are extremely careful not to touch that nerve and its
rare for those complications to occur. But, he says, "if we can
move the focus to the bone surface, away from that nerve, we
may create an even safer, less extensive surgical procedure
than the ones we perform today."

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