Q: Does exercising facial muscles work?

If you exercise your facial muscles, can you keep your face from sagging? P.J., Cambridge
Alas, no. When faces fall with age, the real problem is not lack of muscle tone but loss of collagen in the skin, the tug of gravity on fat and fascia (the gristly tissue that covers muscles), and the stretching of facial ligaments.

When you pinch a baby's cheek, that nice, firm feel comes from lots of good, healthy collagen; when you pinch the skin of an older person, that plump feel is gone, in part because of the loss of collagen. Fat also slides downward as people age. The cherub-like cheeks of childhood disappear because "the fat that covers that area, instead of being on top, has come down an inch and a half," said Dr. William Silver, an Atlanta plastic surgeon and vice president of the American Academy of Facial, Plastic, and Reconstructive Surgery.

Lots of people try facial exercises, says Dr. Mack Cheney, director of facial, plastic, and reconstructive surgery at the Massachusetts Eye and Ear Institute. "It makes sense that if you work out these muscles like any other muscles, it would increase the tone, but you don't see it. Facial aging is not a muscular issue -- it's the fascial plane. And exercise doesn't do anything with that. The fascia and fat move and the skin lengthens because of that."

All of which means that you have to either learn to love your aging face or get a face lift. One good, relatively new option, Cheney said, is the "mini face lift." Instead of subjecting patients to long incisions and general anesthesia, doctors can now make small incisions under local anesthesia on the top of or just behind the ear and pull up the fascia in the face. "It's more subtle than with a real face lift," said Cheney, adding that many people prefer it a full lift.

JUDY FOREMAN