How does a face age, and what should be treated first?

Wrinkles are what people notice. Structure is what changed first.

Answered by

Dr. Simon Ourian, M.D.

Published

December 7, 2026

Reviewed

December 7, 2026

A face ages from the inside out. From about thirty, it loses bone density and support, and the tissue above shifts down over the cheeks and jaw. Wrinkles are the surface sign of that change. Dr. Ourian looks at structure first and addresses it before skin, because surface work done first is calibrated to a face that is still changing shape.

Structure goes first

“the first thing I look at is a bone structure. So, we age with our bones first.” “A lot of people think facial aging is only about wrinkles and hollowness, but honestly, one of the biggest parts of aging is structural changes, structural loss that we have. As we get older, we lose bone density.”

As support is lost, the soft tissue moves down.

“We We have loss of support and the tissue starts shifting downward, especially around your cheeks and your jawline. And that's how you start to look older.”

What he fixes first

Structure that is shrinking or asymmetric comes before anything else.

“So, if I see someone's bone structure is getting smaller or they're asymmetrical, I try to fix that first.”

Four ways faces age

Not everyone ages the same way, and the plan follows the pattern.

“Some people age by Some people age by getting saggy. Some people get hollowed. Some people get more sunken in. Some people have more extra fat in their face. So, depending on what's the problem is, I can customize it the best way possible”

Pattern	What it looks like	Where a plan usually starts
Saggy	Tissue sliding over the jaw and neck	Tightening, with support restored
Hollow	Volume lost under the eyes and at the temples	Restoring volume where it is gone
Sunken	Cheeks and midface flatten	Restoring structure and contour
Extra fat	Fullness along the jaw and under the chin	Reducing fat with ultrasound or radiofrequency

What happens to collagen

Collagen breaks down with age and sun, faster on the neck. The capacity to make it does not disappear.

“Remember, our skin, even when we're into our 80s and 90s, you have the map, you have that blueprint in your skin. All we need to do is to jolt it again one more time.” “But the skin on your neck is thinner, collagen breaks down faster, and there is really less structural support overall on your neck.”

Enhance, not change

Patients want to look like themselves. He works from photos of how they looked ten years ago.

“They want to still look like themselves, just perhaps a little bit better” “I I care about making people look like a better version of themselves and I listen, I look at people's pictures from 10 years ago to now”

Why simple is usually the answer

“Uh and I really think looking beautiful could be very easy if you know what you're doing and if you don't follow trends necessarily.”

Back to Ask Dr. Ourian for more answers from Dr. Simon Ourian.

The figures in this answer reflect Dr. Ourian's observations in his own practice
and are not drawn from published research. This content is for information only
and is not a treatment recommendation. Book a consultation to discuss your own case.

Dr. Simon Ourian is founder and medical director of Epione Beverly Hills, with close to 30 years of practice.

Frequently asked questions

What ages first in the face?

Structure. Dr. Ourian says bone density and support start to decline from about age thirty, and the tissue above shifts down over the cheeks and jaw.

Is facial aging just wrinkles?

No. Wrinkles are the surface sign. Much of what makes a face look older is loss of structure and support underneath.

What does Dr. Ourian treat first?

Structure that is shrinking or uneven, before surface treatments. Surface work done first is calibrated to a face that is still changing shape.

Does everyone age the same way?

No. Some faces sag, some hollow, some sink, and some gain fat. The treatment plan follows the pattern.

Can older skin still make collagen?

Yes. Dr. Ourian says the skin keeps its blueprint into the eighties and nineties, and treatment prompts it to rebuild collagen.