Facial bone aging: An update and literature review

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, and key craniofacial journals (2020–2023) was performed using predefined keywords related to facial bone aging, orbital remodeling, maxillary and mandibular resorption, mechanotransduction, and advanced imaging. Studies were eligible if they (1) involved human subjects ≥18 years, (2) reported quantitative or clearly described craniofacial skeletal changes, and (3) used validated imaging or morphometric techniques. Exclusion criteria were: case reports with ≤5 patients, non-craniofacial skeletal studies, purely soft-tissue analyses, and articles lacking primary data. The search yielded 1,243 records; after screening and full-text review, 72 studies met the inclusion criteria. Each included study was classified according to the Oxford Centre for Evidence-Based Medicine (OCEBM) levels. Results Across the included studies, orbital enlargement averaged 15–20% by the seventh decade, maxillary height decreased by 8–15%, and mandibular angles increased by 3–7°. Distinct resorption patterns were observed around the periorbital region, pyriform aperture, and alveolar processes. Women showed greater orbital change, whereas men exhibited more pronounced mandibular remodeling. Ethnic and hormonal influences, as well as mechanotransduction-related loading changes, contributed to interindividual variability. A summary of methodological characteristics and key outcome parameters for representative studies is provided in Table 1 to facilitate comparison across imaging modalities and analytical approaches. Conclusion Facial bone aging is a fundamental component of craniofacial aging with important implications for aesthetic, reconstructive, and dental practice. Advanced imaging and standardized morphometric analysis now allow more precise characterization of region-specific skeletal changes, supporting evidence-based treatment planning and patient counseling. Further longitudinal and multi-ethnic studies are needed to refine preventive and regenerative strategies targeting age-related skeletal remodeling.