What Makes People Look Old(er) When We Don't Have Wrinkles or Sagging?

A good example of my question might be looking at Hollywood. Guys who are in their 40's who do not have wrinkles or sagging but they are still obviously in their 40's. What makes them look that age without any wrinkles or sagging skin? I've looked closely at pictures but can't determine what it is that doesn't make them look like they are on their 20's.

Doctor Answers 4

Poor skin quality also makes you look older

I agree completely with the answers below about loss of bony structure and underlying tissue support. Another issue that contributes to the appearance of aging is the quality of the skin itself.

When you look at a child's skin you see smooth, plump skin without wrinkles, bumps, spots, scars. The pores are small, almost invisible. Over time, with continued sun exposure, gravity, repetitive muscle action, smoking, environmental toxins, glycemic diet, weight fluctuations and hormonal changes, skin begins to change. Lines develop, brown spots and broken blood vessels appear, pores enlarge, bumps and rough spots appear and skin develops a faint yellowish thickened stiff appearance. Light doesn't reflect as well giving a dull appearance with loss of glow. If you pinch it, it bounces back sluggishly as elasticity decreases. A recent study showed that even without wrinkles or sagging, people judged the age of test subjects with spots, roughness and dull skin as older than those without those changes.

Resurfacing the skin with topical medications like tretinoin, peels, IPL, and laser treatments can reduce brown spots, rough areas, broken blood vessels, bumpy surface, enlarged pores and restore the light reflecting quality of young, healthy appearance to the skin.

Amarillo Dermatologist

What makes a person look older if there are no wrinkles?

As we get older there is a decrease in the amount of bone and soft tissue which redistributes the facial skin downward, sort of like a deflation of a balloon.

That changes the shape of the face from heart-shape or reverse triangle  of youth to oval shape or pyramid of old age.  The fullness of the upper and middle third of the face decreases.  Those changes reflect the aging process even outside of wrinkling.

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Aging is more than skin deep

I fully agree with Dr. Shafer and Dr. Altman in their comments and won't repeat them.   However, I will add that the skin wrinkling and sagging are only the obvious surface issues that people attribute to the appearance of age.  The shift of deeper structures will occur in subtle ways that require an appreciation of the hidden anatomy.  The descent of the cheek fat away from the eyelid fat compartments will lead to the exposure of the bony rim of the lower orbit that gives a sad or tired look.  The migration of fat over the jawline along with loosening of the muscles supporting the corners of the mouth will create the frown of jowling.  Focus on deep structure repositioning for optimum rejuvenation results.

Randy Wong, MD
Honolulu Plastic Surgeon
4.8 out of 5 stars 36 reviews

Looking Older

As people age, the skin quality changes, the bone structure changes, the volume of subcutaneous tissue diminishes.  All of these factors contribute the appearance of age regardless of actual wrinkles.  

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.