Structural aging: the facial recurve concept.

Cutaneous facial aging is responsible for the increasingly wrinkled and blotchy appearance of the skin, whereas aging of the facial structures is attributed primarily to gravity. This article purports to show, however, that the primary etiology of structural facial aging relates instead to repeated contractions of certain facial mimetic muscles, the age marker fascicules, whereas gravity only secondarily abets an aging process begun by these muscle contractions. Magnetic resonance imaging (MRI) has allowed us to study the contrasts in the contour of the facial mimetic muscles and their associated deep and superficial fat pads in patients of different ages. The MRI model shows that the facial mimetic muscles in youth have a curvilinear contour presenting an anterior surface convexity. This curve reflects an underlying fat pad lying deep to these muscles, which acts as an effective mechanical sliding plane. The muscle's anterior surface convexity constitutes the key evidence supporting the authors' new aging theory. It is this youthful convexity that dictates a specific characteristic to the muscle contractions conveyed outwardly as youthful facial expression, a specificity of both direction and amplitude of facial mimetic movement. With age, the facial mimetic muscles (specifically, the age marker fascicules), as seen on MRI, gradually straighten and shorten. The authors relate this radiologic end point to multiple repeated muscle contractions over years that both expel underlying deep fat from beneath the muscle plane and increase the muscle resting tone. Hence, over time, structural aging becomes more evident as the facial appearance becomes more rigid.