Evidence and References
The information presented throughout the Facial Ageing Resource Centre and Dr Raj’s blog articles is informed by published anatomical, ageing, and facial rejuvenation research.
While individual treatment recommendations require a personalised medical consultation, these articles are based on current understanding of facial anatomy, skin biology, soft tissue ageing, and skeletal remodelling.
Key references include:
Rohrich RJ, Pessa JE. The Fat Compartments of the Face: Anatomy and Clinical Implications for Cosmetic Surgery. Plastic and Reconstructive Surgery. 2007. Described the compartmentalised nature of facial fat and its role in facial ageing. ([PubMed][1])
Mendelson B, Wong CH. Changes in the Facial Skeleton With Aging: Implications and Clinical Applications in Facial Rejuvenation. Aesthetic Plastic Surgery. 2012. Demonstrated the importance of age-related bone resorption in facial ageing. ([PubMed][2])
Wong CH. Aging Changes in the Craniofacial Skeleton and Facial Fat Compartments. Facial Plastic Surgery Clinics of North America. 2015. Review of skeletal remodelling and soft tissue changes that contribute to facial ageing. ([PubMed][3])
Wan D, Amirlak B, Rohrich RJ, Davis K. The Clinical Importance of the Fat Compartments in Midfacial Aging. Plastic and Reconstructive Surgery. 2014. Reviewed the relationship between facial fat compartments and age-related volume changes. ([PMC][4])
Lambros V. Observations on Periorbital and Midface Aging. Plastic and Reconstructive Surgery. 2007. Influential photographic analysis challenging traditional assumptions regarding facial descent and ageing. ([Wiley Online Library][5])
Stuzin JM. The Facial Fat Compartments Revisited: Clinical Relevance to Aging and Facial Rejuvenation. Clinics in Plastic Surgery. 2019. Contemporary review of facial fat compartment anatomy and ageing. ([Scholarship Miami][6])
Mendelson BC, Wong CH. Changes in the Facial Skeleton with Aging. Updated review of skeletal ageing and its implications for facial rejuvenation. ([Springer Link][7])
Walczak A et al. Insight into Age-Related Changes of the Human Facial Skeleton. Scientific Reports. 2023. Modern analysis of age-related skeletal changes affecting facial appearance. ([PMC][8])
Frontiers in Cell and Developmental Biology, July 2021, pages 1-19
Nature Reviews Materials, July 2020, pages 730-747
Plastic and Aesthetic Research, January 2021, pages 1-24
Ageing Research Reviews, May 2020, ePublication
Bio-Medical Materials and Engineering, September 2023, pages 473-480
Journal of Cosmetic Dermatology, April 2004, pages 76-87
Aesthetic Cosmetology and Medicine, June 2023, pages 91-95
Journal of Cosmetic Dermatology, March 2024, pages 964-969
Matrix, November 1993, pages 441-446
Aesthetic Surgery Journal, June 2021, pages 723-738
Aesthetic Plastic Surgery, February 2021, pages 296-301
Journal of Clinical and Aesthetic Dermatology, January 2020, pages 44-49
Dermatologic Therapy, September 2022, pages 1-9
Plastic and Reconstructive Surgery – Global Open, April 2023, pages 1-10
Harvard University School of Public Health, Website, accessed December 2024
Nutrients, April 2023, pages 1-20
The American Journal of Medicine, May 2025, pages 1-14
Drug Design, Development and Therapy, October 2014, pages 1,923-1,928
Oyetakin-White P, Suggs A, Koo B, et al. Does poor sleep quality affect skin ageing? Clin Exp Dermatol. 2015;40(1):17-22.
Hughes MC, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med. 2013;158(11):781-790. 24% reduction in photoageing with daily sunscreen use.
De Pessemier B, Grine L, Debaere M, et al. Gut-skin axis: current knowledge of the interrelationship between microbial dysbiosis and skin conditions. (Frontiers/related reviews, 2021 onward).
Cotofana S, et al. The Anatomy of the Aging Face: A Review. Facial Plast Surg.
Dove Medical Press, CCID 2021 Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers.
Lampridou M, et al. The Effectiveness of Polynucleotides in Esthetic Medicine: A Systematic Review. J Cosmet Dermatol. 2025.
Cancer Council Australia / ARPANSA UV Index data; SunSmart Victoria Melbourne/Hobart winter UV data.
Impact of Smoking and Alcohol Use on Facial Aging in Women: Results of a Large Multinational, Multiracial, Cross-sectional Survey. J Clin Aesthet Dermatol. 2019.
Srikanthan P, Karlamangla AS. Muscle Mass Index as a Predictor of Longevity in Older Adults. American Journal of Medicine. 2014.
Finding: greater muscle mass in older adults was associated with lower all-cause mortality.
Li R, Xia J, Zhang XI, et al. Associations of Muscle Mass and Strength with All-Cause Mortality among US Older Adults. Medicine & Science in Sports & Exercise. 2018.
Finding: low muscle strength was independently associated with increased all-cause mortality risk.
Srikanthan & Karlamangla - muscle mass and longevity (Am J Med, 2014)
Leong et al. PURE study - grip strength and mortality (Lancet, 2015)
Cruz-Jentoft et al. - sarcopenia consensus (Age and Ageing, 2019)
Bauer et al. PROT-AGE - protein recommendations in older adults
Fisher et al. - collagen/photoageing mechanisms
Franceschi et al. - inflammaging concept
Alam M, Han S, Pongprutthipan M, et al. Efficacy of a needling device for the treatment of acne scars: a randomized clinical trial. JAMA Dermatol. 2014;150(8):844–849. doi:10.1001/jamadermatol.2013.8687.
Sitohang IBS, Sirait SAP, Suryanegara J. Microneedling in the treatment of atrophic scars: a systematic review of randomised controlled trials. Int Wound J. 2021;18(5):577–585. doi:10.1111/iwj.13559.
Shen YC, Chiu WK, Kang YN, Chen C. Microneedling monotherapy for acne scar: systematic review and meta-analysis of randomized controlled trials. Aesthetic Plast Surg. 2022;46(4):1913–1922. doi:10.1007/s00266-022-02845-3.
Mujahid N, Shareef F, Maymone MBC, et al. Microneedling as a treatment for acne scarring: a systematic review. Dermatol Surg. 2020;46(1):86–92. doi:10.1097/DSS.0000000000002020.
Yang Y, et al. Comparing the efficacy and safety of microneedling and its combination with other treatments in patients with acne scars: a network meta-analysis of randomized controlled trials. Arch Dermatol Res. 2024.
Situm M, et al. A single-center trial to evaluate the efficacy and tolerability of four microneedling treatments on fine lines and wrinkles of facial and neck skin. Aesthet Surg J. 2021. doi:10.1093/asj/sjab052.
Bailey AJM, Li HOY, Tan MG, Cheng W, Dover JS. Microneedling as an adjuvant to topical therapies for melasma: a systematic review and meta-analysis. J Am Acad Dermatol. 2022;86(4):797–810. doi:10.1016/j.jaad.2021.03.116.
Gowda A, Healey B, Ezaldein H, Merati M. A systematic review examining the potential adverse effects of microneedling. J Clin Aesthet Dermatol. 2021;14(1):45–54.
Chu S, Foulad DP, Atanaskova Mesinkovska N. Safety profile for microneedling: a systematic review. Dermatol Surg. 2021;47(9):1249–1254. doi:10.1097/01.DSS.0000790428.70373.f6.
Manstein D, et al. A systematic review of the comparison between needling and ablative fractional lasers in the treatment of atrophic and hypertrophic scars. Lasers Med Sci. 2023.
References below are provided for readers interested in exploring the underlying evidence in greater detail.
https://pubmed.ncbi.nlm.nih.gov/17519724/"The fat compartments of the face: anatomy and clinical ..."
https://pubmed.ncbi.nlm.nih.gov/22580543/ "Changes in the facial skeleton with aging"
https://pubmed.ncbi.nlm.nih.gov/26441110/ "Aging Changes in the Craniofacial Skeleton and Facial ..."
https://pmc.ncbi.nlm.nih.gov/articles/PMC4174112/ "The Clinical Importance of the Fat Compartments in Midfacial ..."
https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118655412.ch65? "Facial anatomy and ageing"
https://scholarship.miami.edu/esploro/outputs/journalArticle/The-Facial-Fat-Compartments-Revisited-Clinical/991031757930502976? "The Facial Fat Compartments Revisited: Clinical Relevance to ..."
https://link.springer.com/article/10.1007/s00266-020-01823-x? "Changes in the Facial Skeleton With Aging: Implications and ..."
https://pmc.ncbi.nlm.nih.gov/articles/PMC10667279/ "Insight into age-related changes of the human facial skeleton ..."
https://pmc.ncbi.nlm.nih.gov/articles/PMC11185368/
https://jcadonline.com/aesthetic-complications-visual-loss-filler/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10627584/