Background: Reshaping of the face with age is a result of volume change and loss of support. It is not well understood which tissues are involved in this process. Recent publications suggest that adult bone growth may have a significant role. Objective: We report a longitudinal cephalometric analysis of midfacial growth in adults to determine the role of bone in facial aging. Methods: The Behrents modification of the Bolton Cephalometric study in patients up to age 83 was reviewed. A trigonometric analysis targeted orbital and anterior maxillary growth. Results: Facial bone growth is shown to continue throughout adulthood. Anterior descent creates increased bone projection. Conclusions: The appearance of facial aging is caused by attrition of soft tissue volume and loss of support. The deficiency of maxillary bone projection seen in some patients, with tear trough depression and negative vector eyelid (polar bear), preexists adulthood and is unmasked with age.
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