As we age not only does the skin becomes less elastic and thin, but our bony skeleton also becomes thinner and smaller. The fat “baby fat” disappears and it all results in hanging empty skin with less architectural aesthetics. The atrophy of the fat is addressed with fillers.  The skin thinness and lack of elasticity is addressed with various lifts whether face lift, abdominoplasty, breast lift or mons pubis lift.  Some require arm lifts, and thigh lifts as well.  In some areas the fat disappears more than others. For example how often we hear people say-”if I loose enough weight for my thighs to be thin my face becomes too gaunt”.. Therefore often we do liposuction on the thighs which stubbornly hold on to fat while our face looses it very quickly.  So now what about the shrinking skeleton. We all know that with age we get shorter. However, we also know that even tho we look better after a facelift the area around the mouth rarely improves. ASK DR. STEPHEN COLEN who is trained as a dentist as well as a plastic surgeon. He will be the firtst one to tell you that in order for the area around the mouth to improve very often one may need to do onlay grafts to fill out the bone area under the upper lip so that the lip will not hang like a curtain with pleats.  Only grafts could also be put under the base of the nasal vestibule so that the nose will not look too long and hooked as our face shrinks.  Often we hear people say -”she is so photogenic”. This is often said about models or actresses.  They usually have in common a squere and strong bone structure which we loose as we get older.  So there are many ways to look younger besides just lifts, skin fillers and botox.  ONLAY grafts can also be very necessary.