In the Dermatology office we look for three components that contribute to the look of aging: Bony changes, Skin texture and quality, and loss of volume.
Bony changes occur in the face and the rest of the body as we age. In the face, such changes as widening of the eye sockets contribute to hollowness under the eyes. Other factors such as tooth loss leads to resorption of bone and skeletal changes that affect the face.
Volume loss can be seen in the temples and cheeks, leading to a hollow look. This is most often seen in people that have always been thin, as they age, and those that have recently lost significant weight. This is the reason someone that has been overweight their whole life often appears younger than their age until they lose significant weight for health reasons and suddenly look much older. In addition to volume loss, aging leads to a decrease in the amount and quality of collagen and elastin, resulting in wrinkles, saggy skin, and jowls. Besides normal aging, other factors such as sun damage, smoking, pollution, diet, and stress can all affect these processes.