What part of the midface undergoes regression with aging?

From the Guidelines

The midface region, particularly the malar fat pad, undergoes significant regression with age, resulting in a flattened appearance of the cheeks and more prominent nasolabial folds. This regression is attributed to a combination of factors, including gravity, loss of skin elasticity, decreased collagen production, bone resorption, and fat redistribution, as noted in a recent study on autologous platelet concentrates in esthetic medicine 1. The malar fat pad's descent and medial shift with age contribute to the midface regression, while the maxilla's resorption over time further exacerbates this issue.

Key changes in the midface region with aging include:

• Fat atrophy in the upper cheek region (malar fat pad) 1
• Deep nasolabial folds 1
• Infraorbital hollowness (dark circles under the eyes, tear trough deformity) 1
• Loss of proportion of the skin envelope (loss of subcutaneous fat, downward sagging of the soft tissues) 1

These age-related changes result in a more aged appearance characterized by flattened cheeks, deeper nasolabial folds, and less defined facial contours. Understanding these specific anatomical changes is essential for effective facial rejuvenation approaches, whether through fillers, fat grafting, or surgical interventions, as highlighted in the study on autologous platelet concentrates in esthetic medicine 1.

From the Research

Midface Regression with Age

The midface undergoes various changes as a person ages, including regression of certain areas.

• The maxillary and pyriform angle decreases with age 2
• There is an inferior migration of the fat compartments of the midface during aging, which exacerbates the hollow of the palpebromalar groove and causes a deepening of the nasojugal groove 2
• Changes to the volume of the buccal extension of the buccal fat pad also contribute to the gestalt changes associated with facial aging 2
• The skin dulls, wrinkles, and blemishes, followed by a slow loosening and sagging of soft tissues as they descend from their once-fixed points of the skeletal foundation 3
• Bone resorption also occurs, leading to visible consequences such as hollows and ridges 3

Soft Tissue and Bony Changes

The major findings characterizing midface aging are related largely to the soft tissue, but bony changes also play a role.

• The orbital floor position changes with age 2
• The zygoma and maxilla are affected by bone resorption and changes in the facial structure 4, 2
• Soft tissue suspension devices, such as Endotine midface, can be used to resuspend the cheek flap and improve facial symmetry 5