New research on age-related changes of the mid-face skeleton

Study authors find age-related bone remodeling affects facial angles and widths, independent of gender in the Caucasian population.

A bone resorption center in the posterior maxilla appears to drive age-related changes of the mid-face skeleton. These changes occur regardless of gender at different ages and skeletal locations, according to a study published December 2018 in Plastic and Reconstructive Surgery (PRS). 

The findings help establish a time sequence for when therapeutic options might have better and longer-lasting outcomes, the authors report.

An international group of researchers studied cranial computed tomographic images of 157 Russian Caucasian men and women. There were 10 men and women in each decade, starting at ages 20 to 29 through 80 to 89 years, as well as eight men and nine women in the 90 to 98 age group.

The authors report several changes that occur independently of gender.

Viewed from the right side, the researchers found a change in facial angles that they summarized as a clockwise rotation of the midfacial skeleton, including:

  • An increase in the orbital floor angle, with the greatest increase, of 7.01 degrees, occurring between ages 60 and 69.

  • A decrease in the maxillary angle, with the greatest decrease, of -1.76 degrees, between 40 and 49 years.

  • An increase in the palate angle, with the greatest increase, of 2.66 degrees, between ages 50 and 59 years.

  • An increase in the vomer angle, with the greatest increase, of 10.36 degrees, occurring between ages 30 and 39.

They report that with increasing age, the pterygoid angle decreases, representing a counterclockwise rotation of the bony structures posterior to the maxilla.

The researchers found anthropometric measures, such as the width of the orbit and height of the midface, were smaller in women but regardless of gender decreased with age.

The previously postulated rotational movement of the facial skeleton against the cranial base doesn’t seem to be the driver behind changes the authors observed in this study, according to the authors:

“Based on the results of our investigation, it might be more appropriate to describe the facial bony changes as an age-related event caused by bone remodeling with consequent changes in facial angles and widths independent of gender in the Caucasian population,” the authors write.

Noting how these findings might translate to practice, the authors point out that the American Society of Plastic Surgeons’ 2016 procedure statistics show that patients ages 40 to 54 had the highest number of minimally invasive treatments of all groups in the survey. This makes sense given the researchers found those are the years when the greatest change in the maxillary angle occurs - a change that significantly impacts the shape of the appearance of the midface.


The study authors report no relevant disclosures.


Cotofana S, Gotkin RH, Morozov SP, et al. The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skeleton: A Computed Tomographic Imaging-Based Evaluation. Plast Reconstr Surg. 2018;142(6):1447-1454.