The Hammock Hypothesis: An Integrative Conceptual Framework for Facial Aging

Background Facial aging is a multilayered and regionally heterogeneous process involving coordinated changes in the facial skeleton, fat compartments, retaining structures, fascial continuity, mimetic activity, and skin. Existing anatomical models have advanced understanding of age‐related facial change, but may not fully explain how interactions across tissue layers and neighboring regions become expressed as recognizable surface phenotypes. This narrative review examines current concepts of facial aging and proposes the Hammock Hypothesis as an integrative structure–function framework. Methods Relevant literature was synthesized thematically across six domains: skeletal remodeling; superficial and deep fat‐compartment change; retaining ligaments and septal support; superficial musculoaponeurotic system, fascial planes, and soft‐tissue continuity; skin envelope and dermal aging; and dynamic influences. These concepts were organized into four interrelated dimensions of facial support behavior. Results The Hammock Hypothesis interprets visible facial aging as progressive disequilibrium within a mechanically coupled multilayer support system. The four proposed dimensions are: support base and foundational projection; anchoring and suspensory restraint; load transmission and dynamic redistribution; and surface deformation and visible expression. This framework relates whole‐face support behavior to regional manifestations including tear trough prominence, midfacial flattening, nasolabial fold accentuation, jowl formation, marionette change, and temporal hollowing. Conclusion The Hammock Hypothesis is not intended to replace existing anatomical models, but to provide an integrative conceptual framework for clinical interpretation. It should be regarded as a heuristic and hypothesis‐generating model requiring validation through imaging, biomechanical analysis, and phenotype‐based clinical studies.