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It’s not always fatigue: aging and facial expression

Published Oct 2, 2026 3 min read

It’s not always fatigue: aging and facial expression

Natural skin aging has several causes that we notice from day to day. Sometimes it may look like simple fatigue, but changes in facial structures also contribute to that appearance.

Aging around the eyes occurs when ligaments lose firmness and fat shifts, producing bags, laxity and fine lines beneath the eyes. In addition, the skin in this area is 4 times thinner than skin in other facial areas. Some dark circles have a vascular origin and can appear blue or purple, while others accumulate excess melanin, producing a brown or gray appearance.

The tear trough creates a shadow and can also make the under-eye area look dark.

The nasolabial fold is a natural line that runs from the side of the nose to the corners of the mouth. It becomes more pronounced as volume is lost in the upper and middle thirds of the face.

Treatment options for these concerns range from hydrating the skin’s surface with retinol or hyaluronic acid to restoring volume in areas that have lost it with intradermal or supraperiosteal hyaluronic acid, as appropriate for each case.

The loss of collagen and elastin, the fibers that support the skin’s tissues, makes the skin thinner and less able to conceal deeper structures. Biostimulators can help create or stimulate the production of these fibers and support the exposed tissues.

Lipolytic enzymes help control excess fatty tissue so it does not protrude, helping manage its appearance.

Collagenase helps remove dead or scar tissue and stimulates skin regeneration.

HIFU is a non-invasive ultrasound technology that uses high-frequency waves to heat the deeper layers of the skin and stimulate natural collagen production.

INTRACEL uses fine microneedles to perforate the dermis and deliver radiofrequency thermal energy directly to deeper tissue without damaging the epidermis. The heat and microperforations stimulate fibroblasts to produce more collagen and elastin.

Facial aging results from a combination of factors that gradually affect bone, ligaments, muscles, and cells. Every patient is different, and lifestyle also influences these factors.

DR. VIRGINIA CORONEL

This content is for informational purposes and does not replace an in-person medical assessment. Any treatment recommendation is confirmed during a consultation.

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