Facial plast Surg 2013; 29(01): 003-012
DOI: 10.1055/s-0033-1333840
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Aging Changes of the Periorbita, Cheeks, and Midface

William H. Truswell IV
Private Practice, Aesthetic Laser and Cosmetic Surgery Center, Northampton, Massachusetts
Facial Plastic Surgery, Division of Otolaryngology, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
› Author Affiliations
Further Information

Publication History

Publication Date:
20 February 2013 (online)


The periorbita, cheeks, and midface are an area of complex facial form and function. There is a particular pleasing visual harmony of these regions in the youthful face. With time, the robust glow and fullness of youth fades and diminishes. The skin is the first component to show the passage of time as it dulls, wrinkles, and blemishes. This is followed by a slow loosening and sagging of soft tissues as they descend from their once-fixed points of the skeletal foundation. The smooth transitions between regions are separated and hollows and ridges appear. These processes continue throughout life and eventually are accompanied by the visible consequences of bone resorbtion. The faces age, and as the countenance of the human spring turns through summer into autumn, function follows form, and symptoms accompany signs. A thorough understanding of both youthful and elder anatomy as well as the stigmata of aging is prerequisite to perform rejuvenating procedures. This article discusses these changes and how the older anatomy becomes the new norm.