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They are effectively predisposed to manifest aging changes prematurely. Features that portend poor support include a retrusive supraorbital bar, midface hypoplasia, poor zygomatic development (the extreme seen in Treacher Collins syndrome), and microgenia. Regardless of age, once these soft tissue changes are manifest, a significant degree of bony deficiency exists. Correction of the bony element has the potential to deliver a more harmonious facial rejuvenation. Those individuals who started low down the curve should be considered for a skeletal augmentation, not only to reverse the aging changes but also to bring their natural state higher up the curve so that the soft tissues are better supported for a more attractive look.

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