Older Skull Image
Orbits more "droopy" at the outside lower edge
Cheekbones lower and flatter
Younger Skull Diagram
Orbits more round
Cheekbones higher and more prominent at the upper edge
As we mature, our facial bones change with time. Specifically, our orbits (eye sockets) become larger and more trapezoid in shape, with more pronounced thinning of the bone in the outer lower and inner upper edges. In addition, if you look at the skull from the side you will notice that the mature skull becomes flatter in the area at the top of the lower edge of the eye sockets.
Image 1 is a photo of a skull that has aged. While this is not an overtly elderly specimen, you can still compare the orbits (eye sockets) with those in image 2 below. The most obvious difference is that in the diagram the orbits are rounder than in the photograph of the skull above.
I believe the first step in mitigating age-related facial structural change is to inject a long lasting filler against the bone just below the orbits on the outer area and directly onto the cheek bone. This serves to provide a basis for a youthful appearance. If you think of the face like a bed - this repairs the structure of the box-spring. My philosophy is to level box spring first, then even out the mattress before smoothing the sheets!
By injecting against the bone of the orbit, the lower orbital rim is enhanced, the cheek bone is made more prominent, and the angle of the facial structure becomes less flat and more youthful. This will also blunt the folds of skin on the sides of the nose (nasolabial folds) and efface some wrinkles. In addition, when a series of injections are made against the zygoma (cheek bone) at about a 45 degree angle upward and outward, this can lead to a young appearing classically feminine facial appearance. For males we typically inject in this area on a more transverse line rather than an such an upward 45 degree angle. We prefer Juvéderm Voluma™ for this application in our practice for its stiffness and long duration. A softer, more pliable product can then be injected in the more superficial areas and lines. To refine the appearance skin resurfacing or peels may be used to give the skin a youthful glow and treat fine wrinkles. For pigment irregularities such as brown or red spots, IPL is ideal but can only be used in certain skin types.