It's another sunny day in Miami Beach, and the waiting room of cosmetic dermatologist Leslie Baumann, M.D., is packed with lean, bronzed women, lined up like pretzel sticks in a box. Among them is Sarah,* the 39-year-old host of a local TV show, who's frantic about her glabellar lines—that's skin-speak for the vertical lines (a.k.a. 11's) that tend to show up between the eyebrows when you hit your mid to late thirties. She seems a little annoyed, but that's partly the lines' fault.
See, in addition to making you look older, they can give you a slightly pissed-off appearance. Old and angry isn't a look any woman covets, certainly not one who makes her living as a personality on a morning television show.
From the neck down, Sarah could pass for a high school athlete. Weighing in at 120 pounds, with a tight little butt and flat abs, she's fitter than she was as a teenager. The old face/young body contradiction is one that's familiar to Baumann, who has been known to tell clients in the past, "Sorry, you just might have to choose between your face and your rear end."
Her words echo a quote that is often attributed to French actress Catherine Deneuve, who reportedly said, "After a certain age, you have to choose between your fanny and your face." Here's what she meant: Many of the things you do in the name of staying in shape—counting calories, tallying fat grams, following a uber-healthy nutrition plan, logging hours at the gym—begin to do a number on your face as you close in on 40. You start to lose facial volume, which can cause eyes to look slightly sunken, cheeks to hollow out, and skin to lose its firmness and elasticity. Maintaining a low body mass index (BMI) exacerbates the problem because fat is the very thing that helps plump out lines and wrinkles.
"When you lose weight, the face is the first place that shows it," says Baumann, who conducts research at the Baumann Cosmetic Research Institute, in addition to treating patients in her office. "The fat pads under the eyes go first, then you see it above the smile and down to the chin, then the cheeks." At the same time, gravity comes into play, and the elastin and collagen fibers that allow skin to stretch and spring back weaken, causing skin to sag.
All of which leaves Sarah (and women like her) with a rather unappealing choice: carry an extra 10-plus pounds to keep her face looking youthful, or keep her weight down and wear an extra 10-plus years on her face. But do we have to compromise? Or is there a way to have both our face and our derriere fight gravity? We turned to experts in the fields of dermatology, nutrition, and exercise physiology to find out.
Facing the Music
As early as your mid-twenties, faint creases start to appear on your face—usually across your brow and around your eyes. In your mid-thirties, those creases kick off their shoes and make themselves at home, settling in as full-fledged lines. Soon after, crow's-feet and smile lines join the party, and the dreaded 11's hit you where it hurts: right between the eyes. As you lose volume in the upper part of your face, the lower part starts to sag. Tending to these changes can feel like a game of Whac-A-Mole—as soon as one problem is addressed, another pops up.
"To maintain youthfulness, the human face begs to have fullness," says Rod Rohrich, M.D., professor and chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center. And by fullness he means fat—whether it gets there the old-fashioned way or with the help of a dermatologist or plastic surgeon.
In 2007, Rohrich led a groundbreaking study at UT Southwestern that shed light on just how important fat is for the face. Prior to his research, skin-care experts believed that subcutaneous facial fat (the fat just below the surface of the skin) was one confluent mass that aged at the same rate. Rohrich and his team discovered that the face is actually made up of 21 individual fat compartments, each of which ages at a different pace. Imagine your face as a three-dimensional puzzle, with fat divided into distinct units around the forehead, eyes, cheeks, and mouth. The way your face ages is at least partially characterized by how these separate compartments evolve as you grow older. Staying too thin can eventually cause some or all of those compartments to sag like day-old party balloons.
To keep those fat compartments looking as if they're positioned beneath the skin of a twenty-something, you need to maintain about 15 percent body fat, says Doris Day, M.D., a clinical assistant professor of dermatology at New York University Langone Medical Center and author of Forget the Facelift. Women with naturally fuller faces have more leeway because they have more fat in each compartment. On the flip side, "women with thin, angular faces may need 20 to 25 percent body fat to keep a youthful face," says Day. Especially in their forties.