Why some faces age 20 years slower: the ageing formula

People often ask me how certain celebrities seem to defy time - looking a genuine ten, even twenty years younger than their age. There's no secret potion. There's a formula, and once you understand it, you know exactly where to look and what to track.

The four tissues that actually age

Your face is built from four layers: bone, fat, muscle and skin. As we get older, all four deteriorate - but not at the same rate, and not in the same places. Some parts of a face are ageing quickly while others barely change for years. If you're aware of that, and you're tracking which layer is deteriorating fastest for a particular person, you can intervene early and keep them looking like themselves for a lot longer. I want to be honest here: nobody stops the clock. You're still going to get older. The goal is to do it more slowly, and more gracefully, than gravity and time would otherwise allow.

The skull is the one layer we genuinely can't do much about - bone remodelling is a slow biological process outside the reach of non-surgical treatment. So in practice, the real work happens across fat, muscle and skin.

Fat: the layer that's hardest to get right

Fat is usually addressed with dermal filler, and of the three, it's the one I find most difficult to get right. That's because facial fat isn't one simple layer - it's several. There's deep fat and superficial fat. There's fat that moves with your expressions, and fat that sits stationary underneath. Each behaves differently, and each disappears on its own timeline.

Different areas of the face lose their fat at different life stages. Some pockets start thinning in your late twenties. Others hold on until your thirties, forties, even fifties. That means every face arrives at a consultation with its own unique pattern of loss - and restoring it isn't just a matter of "adding volume back." It has to go back in roughly the configuration it would have followed naturally, or the result looks off, even if you can't say exactly why.

This is also where the muscle-fat balance starts to matter. As fat volume drops but the muscles underneath stay just as strong, the face is able to move a lot more freely than it used to. The result, if left unaddressed, is that expressions can start to look exaggerated - almost a caricature of someone's younger self - simply because there's less fat cushioning and controlling that movement.

Muscle: the balance between movement and wrinkles

Muscles create wrinkles by repeatedly scrunching the skin above them - that's simply how expression lines form over decades. The instinct is to turn that movement down, and anti-wrinkle injections do exactly that. But this is a balance, not a switch. Reduce muscle activity too much and the face stops moving altogether - and a face that doesn't move isn't just "less wrinkly," it reads as wrong. People notice a frozen face faster than they notice a wrinkled one.

Where that balance sits is different for every face I see. It depends on how strong someone's muscles are to begin with, how expressive they naturally are, and how much fat is left to support the movement in the first place. That's precisely why I don't work from a standard dose or a fixed pattern - it has to be judged, face by face.

Skin: where you can do the most, but where it's hardest

Of the four tissues, skin is the one where you genuinely have the most scope to make a difference. It's also the most difficult to change - because it took a long time to get to where it is, and skin ageing is heavily shaped by how someone has actually lived. Sun exposure, smoking, alcohol, excess sebum, and simply not cleansing properly all quietly erode skin quality over years. None of that reverses overnight.

Skin ageing also isn't one problem - it's several, layered on top of each other:

• Pigmentation
• Redness
• Texture
• Enlarged pores
• Sun spots
• Cumulative UV damage

Each of these needs to be treated differently, and treating the wrong one first wastes time. In my clinic we usually start with a proper skin scan to work out what's actually the worst offender, then build a plan working back from that finding rather than guessing.

Common questions

Which of the four - bone, fat, muscle or skin - matters most?

It genuinely depends on the face in front of me. Some people are losing fat volume faster than anything else. Others have strong expression lines but plenty of fat still in place. That's why I don't start with a treatment - I start by working out which layer is deteriorating fastest for that particular person.

Why does fat need to go back in a specific pattern rather than just "wherever it's needed"?

Because different areas of your face lost their fat at different points in your life, in a particular sequence. Replacing it in a way that respects that natural pattern is what makes the result look like you, rather than looking corrected.

If skin is where I can do the most, why start anywhere else?

Often we don't - but skin takes the longest to change, so it's worth knowing early what you're dealing with. A skin scan gives us a genuine baseline, and from there we can decide whether skin, fat, muscle, or some combination of all three, deserves the first move. That decision is really what a consultation is for.

Related at Amara

• Dermal filler
• EMFACE
• What causes facial sagging after 40, and how to lift it

About Dr Paul

I'm Dr Paul Munsanje — a medical doctor with over 17 years in aesthetic medicine, running a doctor-led clinic across Dublin, Warsaw and Marbella. My work is built on facial anatomy, precision and restraint: treating where it genuinely helps, and just as readily talking you out of what you don't need. This journal is where I write down honestly what I tell my patients.