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The jutting edge: Studies show jaw size increases with age, influences aesthetic approach to rejuvenation

Article-The jutting edge: Studies show jaw size increases with age, influences aesthetic approach to rejuvenation

Key iconKey Points

  • Research shows that patients' mandibles grow and widen with age
  • The insights provided by this research may influence the ways in which facial augmentation is approached

Dr. Rohrich
DALLAS — A strong jaw, a prominent lower face: images of masculinity in men and of strength and character in women — and, apparently, of advancing age. Recent research undertaken by physicians at University of Texas (UT) Southwestern Medical Center, Dallas, is shedding new light on the role of the aging mandible in perceptions of youth and beauty.

JAW-DROPPING RESEARCH The research, recently published in Plastic and Reconstructive Surgery , was spearheaded by Joel E. Pessa, M.D., assistant professor of plastic surgery at UT Southwestern, and Rod Rohrich, M.D., F.A.C.S., chairman of plastic surgery there.

Dr. Pessa explains, "We noted that some people tended to have an increase in their jaw size with age," and they wanted to explore why and how. For their research, the surgeons obtained serial radiographs of eight men and eight women, and discovered that, over their lifetimes, the patients' mandibles continued to grow and widen as they aged.

It's been no secret that people's faces change as they age, but the UT researchers were surprised to observe the manner in which different portions of the face aged. "Yes, the entire facial skeleton does increase with age," Dr. Pessa relates, "but the jaw does so at an accelerated rate compared to the rest of the face. Therefore, there's a change in the shape of the face, and in the relative size of the jaw." It's also common knowledge that the redistribution or loss of facial fat as a person ages accentuates the appearance of age. "A youthful face is full and robust and generally perceived as more attractive," Dr. Rohrich says. "As we age, we lose this fullness early, especially around the eyes and outer cheek areas." So, how do the bony changes noted by the researchers relate to these fatty changes? Drs. Pessa and Rohrich explain that the bone ages independent of fat, "relying on hormones, stress factors, loss of teeth, etc. Fat also changes, and jowling gives the added effect that the chin has grown in size." This insight on the ever-lengthening mandible yields a better understanding of how bone and fat, and its compartmentalization, have a synergistic effect, creating a more aged look. To aesthetically address this, Dr. Pessa notes, "The treatment now is to try to decrease the amount of soft tissue around the chin with face lifting and liposuction, and by augmenting the cheeks — which makes the chin appear smaller."

NEW DIRECTIONS How do Dr. Pessa and Dr. Rohrich's discoveries influence their approach to patients requesting correction of the signs of aging? "We think completely differently in terms of adding volume to specific areas in order to recreate a youthful shape," Dr. Pessa says. "It was the anatomy that unlocked the key as to where we should be augmenting the face." While it may be impractical to reduce the size of the lower face, the bony effects of aging may be countered by selective augmentation of various fat compartments in other facial areas so that the lower face appears smaller relative to the upper face.

These findings may influence cosmetic surgery moving forward. "When long-term and safe fillers are available," Dr. Pessa says, "The younger patient will come to the office for rejuvenation that will be long lasting based on solid science." However, the soft tissue changes will still need to be addressed, he adds. "The facelift is a necessary procedure, and will still be needed when excess skin needs to be removed and repositioned."

This new understanding is paving the way for further studies that promise benefits beyond cosmetic surgery. Dr. Pessa explains, "The knowledge that there are compartments of fat is going to aid diabetes research and the general field of obesity research. Where do we store fat, and why? These are big questions that we're now able to study, because we know where to look. Knowledge of anatomy of the face always benefits and adds precision to what we, as plastic surgeons, do for our patients. [It's] already helped patients and will continue to do so in ways we cannot predict. Some of these [ongoing studies] here at UT will likely have as large an impact as these previous studies" have had, Dr. Pessa says, noting that Dr. Rohrich's team at UT Southwestern is already underway with a full-scale study of the entire body.


Reece EM, Pessa JE, Rohrich RJ. The mandibular septum: anatomical observations of the jowls in aging—implications for facial rejuvenation. Plast Reconstr Surg. 2008;121:1414-1420.

Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119:2219-2227; discussion 2228-2231.

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