Facial bone aging: An update and literature review

Abstract

Background: Facial bone aging is a multifactorial process involving progressive skeletal remodeling, selective bone resorption, and architectural changes that contribute substantially to the aged facial appearance. Craniofacial skeletal changes occur throughout adult life with region-specific bone loss affecting the orbital rims, maxilla, and mandible. Aim: This review summarizes contemporary evidence on facial bone aging, with a focus on morphometric changes, imaging findings, and clinical implications between 2020 and 2023. Method: A systematic literature search of MEDLINE, PubMed, Ovid, Cochrane Library was conducted using predefined keywords related to facial bone aging, orbital remodeling, maxillary and mandibular resorption, mechanotransduction, and advanced imaging. Studies involving adult human subjects that reported quantitative or clearly described craniofacial skeletal changes using validated imaging or morphometric techniques were included. Case reports with <= 5 patients, non-craniofacial skeletal studies, purely soft-tissue analyses, and studies lacking primary data were excluded. Included studies were classified according to Oxford Centre for Evidence-Based Medicine levels. Results: Across the included studies, orbital enlargement averaged 15-20% by the 7th decade, maxillary height decreased by 8-15%, and mandibular angles increased by 3-7 degrees Distinct resorption patterns were observed around the periorbital region, pyriform aperture, and alveolar processes. Women demonstrated greater orbital change, whereas men exhibited more pronounced mandibular remodeling. Ethnic, hormonal, and mechanotransduction-related loading factors contributed to interindividual variability. Key methodological characteristics and outcome measures of representative studies are summarized in Table 1. Conclusion: Facial bone aging represents a fundamental component of craniofacial aging with important implications for aesthetic, reconstructive, and dental practice. Advances in imaging and standardized morphometric analysis enable more precise characterization of region-specific skeletal changes, supporting evidence-based treatment planning and patient counseling. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)