Facial Aging of Midface
The skin represent only the covering for the deeper anatomic elements that project the topography of the aging midface. In the aging midface, these elements have shifted but will always maintain their intimate relationship to one another.
The periorbital soft tissue of youth is a shallow and narrow orbit, described as being an unbroken convex line from the lower eyelid to cheek. With progressive aging, those dimensions become wider and deeper as skeletinization of the orbit normally occurs, beginning in the fourth decade.
Ptotic cheek fat descends to become the melolabial fold, leaving behind a cheek depression that can be accentuated by buccal fat attenuation. As the orbicularis muscle becomes ptotic with aging, its inferior border becomes clinically apparent. This creates the malar crescent over the zygomatic emninence laterally, resulting medially in creation of the nasojugal fold.
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