The perception or reality of a vertically elongated face often prompts questions about whether facial structure continues to change long after adolescence. The shape of the human face is not static; it is a dynamic structure influenced by genetics, ongoing skeletal maturation, daily habits, and the inevitable process of aging. Facial length changes are rarely due to a single cause, but rather a combination of biological processes, functional adaptations, and, in rare instances, underlying medical conditions.
Natural Vertical Growth and Maturity
Facial bone growth does not always conclude in the late teens. Skeletal maturation, particularly in the jaw structure, can continue slowly into the 20s and, in some individuals, even into the 30s and 40s. Longitudinal studies tracking adults have shown that the anterior facial height, the distance from the nose to the chin, can increase by approximately 1.0 to 1.9 millimeters between the ages of 22 and 46.
This late-stage change is often driven by continued growth in the mandible, which can be about twice that of the maxilla. The final stages of skeletal development involve a downward and forward movement of the jaw, which increases the overall vertical dimension of the lower face. This inherent growth pattern is determined by genetics, predisposing an individual to either a long-face structure (dolichocephalic) or a short-face structure (brachycephalic).
The Influence of Soft Tissue Function and Breathing Habits
One of the most significant non-genetic factors influencing vertical facial development is the function of the soft tissues, specifically the tongue and jaw muscles. The face develops optimally when the mouth is closed and the tongue rests against the roof of the mouth, providing natural upward scaffolding for the maxilla. Chronic nasal obstruction, such as from allergies or a deviated septum, forces a person to breathe predominantly through the mouth. This habit keeps the tongue low on the floor of the mouth to open the airway.
This lowered tongue posture removes the internal pressure that helps the upper jaw grow horizontally and forward. Over time, the maxilla and mandible grow in a more vertical direction, leading to a condition sometimes described as “long-face syndrome.” The constant open-mouth posture and downward pressure from the jaw muscles induce a gradual, subtle downward rotation of the mandible. This mechanical shift physically elongates the lower third of the face, resulting in a narrow palate, a recessed chin, and an increased distance between the upper and lower jaws.
In adults, this chronic habit continues to influence the facial profile, contributing to decreased muscle tone and potentially accelerating the appearance of an elongated face. While skeletal changes are less dramatic than in a growing child, persistent gravitational and muscular forces can still lead to subtle remodeling and shifts in dental alignment. Addressing the underlying cause of mouth breathing, such as nasal blockages, is important to mitigate these ongoing functional effects.
How Aging and Volume Loss Alter Facial Appearance
The appearance of a longer face in older adulthood is frequently an illusion created by the redistribution and loss of facial volume, rather than continued skeletal growth. After age 40, a gradual process of bone resorption begins to reshape the facial skeleton, particularly around the eye sockets and the jawline. The recession of the orbital rim and the decrease in maxillary height cause the midface to lose projection and flatten.
Simultaneously, the soft tissues undergo significant changes, including a decrease in skin elasticity and the gravitational descent of fat compartments. The fat pads in the cheeks move downward, and the loss of support from the underlying bone causes the skin and tissues to sag, emphasizing the lower facial structures.
A particularly notable change is the lengthening of the philtrum, the vertical groove between the nose and the upper lip. Studies have measured this upper lip lengthening to be approximately 18 to 19 percent in older adults compared to younger individuals. The combination of a lengthening upper lip, downward-shifted soft tissue, and bone loss at the chin and jawline collectively lengthens the appearance of the lower face. This overall effect makes the face look vertically extended, which is a normal part of the aging process.
Structural Changes Caused by Specific Medical Conditions
In rare instances, a rapid or pronounced change in facial structure and length can be a symptom of an underlying medical condition. The most recognized of these is acromegaly, a hormonal disorder that occurs when the pituitary gland produces an excessive amount of growth hormone and insulin-like growth factor-1 (IGF-1) in adulthood.
Since the growth plates in the long bones are already fused, the excess hormones cause the bones of the face, hands, and feet to grow abnormally. Facial changes include the prominent enlargement of the lower jaw (mandibular prognathism), along with thickening of the nose, lips, and forehead. These structural shifts are often insidious, developing slowly over many years, which can make the diagnosis difficult.
If facial lengthening is accompanied by other systemic symptoms, such as the noticeable enlargement of hands and feet, joint pain, or thickened skin, a consultation with a physician is recommended to investigate the possibility of an endocrine issue.