Wrinkles and fine lines are the most evident manifestation of facial aging. It is not just the skin structural and facial muscles change that contribute to the formation of wrinkle such as loss of elasticity and volume. Changes in bone structure or craniofacial bony aging is one of the elements that causes the appearance of facial aging. Facial bones lose volume with age. Facial skeletal aging include bone atrophy, relative change in bone expansion, shrink, and/or loss, bone thinning. These can result in reduction in facial height and in maxilla and mandible width and depth. The overall distance between key skeletal structures tend to decrease over time because of bone remodeling associated with aging. One example is the decrease in size of Maxilla. In effect, this process creates less available space for the attached muscle and skin, resulting in the inferior displacement of the cheek fat pad and skin which result in the deepening of the melolabial fold. Bone resorption is the process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood. The pyriform remodeling and maxillary resorption cause perioral wrinkling. The resorption of the alveolar ridge affect chin’s shape and its projection change. There is general coarsening of bony protuberances where masticatory muscles are attached.

Using computed tomography (CT) scans, facial bones of men and women across different age groups can be analyzed. The structure of the bones differed between age groups (young 20 to 40, middle-aged 41 to 64 and older 65 and up). Women (between young and middle age) showed the changes slightly earlier than men. In men, most of the changes occurred between middle age and old age. Bone changes associated with aging process will influence the skin and muscles that are attached to the bones, contributing to the aging appearance. Researchers found that in both men and women, the eye sockets became wider and longer. The size and shape of eye-socket became wider and longer. Eye sockets enlarge and the angle of the bones beneath eyebrows decreases which may contribute to the formation of forehead wrinkles (frown line), periorbital lines at the corner of the eye and droopy lower eyelids. The distance between the most prominent part of the brow to the top of the nose decreased, while the cheekbones stuck out less and the opening of the nose bones receded. Aging also affected the bones of the middle part of the face. Reductions in the angles of the brow, nose, and upper jaw bones are found. Changes in nose bones could lead to decreased nasal support and projection. The lower jaw shrunk in both length and height. A decrease in jaw size could flatten the chin and affect the neckline.

Some plastic surgery procedures target the bone aging solutions. By using materials and techniques for skeletal augmentation, plastic surgeons could improve the results of the facial rejuvenations surgery. Skeletal implants can solve bone shrinking issue. Facial exercises helps to restore and prevent bone loss. Facial exercise not only builds muscle fibers and rejuvenate connective tissues of the skin but also revitalize the bones.