Appearance & Function

Facial collapse after tooth loss

What has changed is not your skin but the bone it is stretched over

If you put what you see in the mirror down to ageing, you are looking in the wrong place. Once the teeth have gone, the bone that held them shrinks; the lips fall in, the corners of the mouth droop and the lower face gets shorter. On this page we explain why this happens, when it speeds up, what a denture solves and what it speeds up, and what the one step is that really turns the process around. Send us your X-ray, and we will write to you within 24 hours about what can be read from the image and which options are on the table.

Short answer

The face falls in not because the skin ages but because the bone underneath shrinks. The alveolar bone that holds the root of a tooth recedes after the tooth is taken out, because it no longer carries a load; the loss is fastest in the first year after the extraction and continues more slowly in the years that follow. Lower face height decreases, the upper lip loses its support and falls in, and the corners of the mouth turn down. A denture covers up this appearance but does not stop the bone loss; because it puts the load on the gum, it speeds it up. The only solution that puts the load back inside the bone is an implant.

The cause of the collapse: Shrinking of the alveolar bone that holds the teeth
The fastest period: The first year after the extraction
What a denture does: Covers up the appearance, speeds up the bone loss
Initial assessment: From your images, within 24 hours

Medically reviewed by Bilge Ilgın, Dentist · ImplantologyLast reviewed 2026-08-31

What happens to the face, and why

The first thing that makes you notice the change is photos: the distance between the nose and the chin has got shorter, the upper lip has thinned and slipped inwards, and the corners of the mouth have turned down. The cheeks look sunken and the chin looks as if it juts forward. People call this 'getting old' and look at their skin. Yet what has changed is not the skin of the face but the skeleton that skin is stretched over. The lips and cheeks cannot hold themselves up; the teeth behind them and the bone that holds the teeth keep them out. As this support shrinks, the soft tissue does not stay where it is; it gathers downwards and inwards.

The cause can be put in one sentence: the alveolar bone exists to hold the root of the tooth. This part of the jawbone is constantly renewed by the chewing load coming from the root; the balance between the cells that build bone and the cells that break it down is set by that load. When a tooth is taken out, the load disappears, the balance tips towards breakdown and the bone recedes. The body does not keep feeding a structure that no longer does any work. That is why tooth loss is not a one-off event but the start of shrinkage in that area that will go on for years.

The bone loss does not follow a straight line; it is fastest in the months straight after the extraction. By the end of the first year, the bony ridge in the extraction area has become both lower and thinner; the loss in this first period is noticeably faster than in any later year. The loss is greatest in the outer wall of the bone, the one facing the lip; that is why the ridge loses not its height first but its thickness. After that the pace slows, but the process does not stop: a little more bone goes every year. This is why the change in the face appears in a way nobody can pin down to a particular day.

The upper and lower jaws shrink differently. In the upper jaw, the bony ridge draws upwards and inwards; because the support the upper lip rests against moves back, the lip thins, the groove under the nose flattens and the length of tooth that shows when you smile gets shorter. In the lower jaw, the ridge narrows downwards and outwards, and the lining over it thins. When both happen together, the lower jaw gives the impression of sticking out in front of the upper jaw; this is the look a patient describes as 'my chin has got longer'. Because the bony ridge in the lower jaw is narrower to begin with, the consequences of bone loss catch the eye earlier here.

When the back teeth go, a second loss comes into play, and the most visible change in the face comes from this. The height of the back teeth determines where the lower jaw stops when you bite together; without them, the jaw travels further as it closes and lower face height decreases. The chin turns forwards and upwards, the lips fold over each other and a permanent groove forms at the corner of the mouth. Saliva collecting in that groove keeps the skin constantly moist; the sores that crack at the corner and never seem to heal come from fungi or bacteria that thrive in this moist fold. The lost height is not the cause of the sore; it is the ground that prepares it and lets it keep coming back.

In whom the bone loss progresses slowly, and in whom it progresses fast

This distinction determines how much of the remaining bone goes, and over what time. If you are in the first list, you have time on your side. If you are in the second, the cost of putting it off grows every year.

The tooth can be saved

The gap was filled soon after the extractionAn implant placed early in the extraction site gives the load back to the bone and removes the cause of the bone loss. Because the loss is fastest in the months after the extraction, the decision made during this period shapes the next ten years.
A single tooth was lost and its neighbours are healthyBecause the neighbouring teeth carry on loading their own bone, the edges of the gap stay standing; the bone loss is confined to a narrow area and does not show in the face. The urgency here is not in the appearance but in the neighbouring teeth tipping into the gap.
The teeth were lost to decay or a fracture, not to inflammationWhen gum disease is not involved, the bone walls of the extraction site are still standing. The height of the ridge is kept for longer, and the plan made later stays simple.
You do not smoke and your blood sugar is under controlBoth directly reduce the bone's ability to renew itself. When these two are in order, the bone shrinks more slowly and responds better to treatment.

Saving it is unlikely to hold

You have worn a full denture covering the palate for yearsA denture puts the chewing load not on the bone but on the thin gum tissue over it. Under this pressure the bone keeps shrinking; the denture does not stop the process, it speeds it up. This is also why a denture develops a gap every few years and needs relining.
The teeth were lost to advanced gum diseaseThis disease makes teeth fall out by breaking down the bone in the first place; once the tooth has gone, what is left is a lowered ridge. Because the bone loss starts from a lower point, the change in the facial features becomes visible sooner.
The back teeth have been missing for yearsThe front teeth cannot carry the bite on their own; they wear, splay forwards and lower face height decreases. In this picture the loss is not only in the bone but in where the jaw comes to rest; correcting it needs a plan covering the whole mouth.
Years have passed since the lossThe bone does not stop at some point and rest; it keeps shrinking. As the remaining height and thickness decrease, the area an implant can anchor in gets smaller. This is exactly the irreversible part of waiting: bone that has been lost does not come back on its own.

How we measure how much of the loss we can rebuild

This sequence is for measurement, not treatment. At the end you know how much of the bone has gone, how much of the change in your face comes from this and what can be rebuilt.

1
Send us your X-ray
If you have a panoramic X-ray or a CBCT scan, send it through the form; we write to you within 24 hours about which options are on the table, and you do not need to come in for the initial assessment. If you have a photo taken while your teeth were still in place, add that too; that photo shows the target for the height to be rebuilt.
2
We measure the face
We measure the lower face height at rest and with the teeth together, the support the upper lip receives, the length of tooth that shows when the lips are apart and the direction of the corners of the mouth. These measurements separate how much of the collapse comes from bone loss and how much from lost bite height. They are different problems and are solved in different ways.
3
Clinical examination
We assess the height and thickness of the bony ridge by hand, and look at how thin the lining over it is and, if you wear a denture, at any loose, movable tissue that has formed underneath. Sharp edges on the ridge that can be felt with a finger, and flattening of the area the denture sits on, are signs of an advanced stage of bone loss.
4
3D imaging
The real height and thickness of the bone, how far down the floor of the sinus reaches in the upper jaw and where the nerve runs in the lower jaw can only be measured on a CBCT scan. A panoramic X-ray does not show thickness at all; loss of the outer wall, where bone loss is greatest, cannot be seen on a two-dimensional image. A decision about bone made without seeing a CBCT scan is made on incomplete information.
5
We build the plan from the face, not from the teeth
Once the measurements are done, we first decide where the teeth will go and how long they will be; the position of the implants is chosen to fit this plan, not the other way round. At the try-in stage we show you, on your own face, how much lip support and lower face height will come back. You are not left to guess at the result; you see it before the final teeth are fixed.

Options

These do not all do the same job. Some pull the appearance together, some buy time. Only one removes the cause of the bone loss.

Doing nothing

Leaving the gap empty can look like not making a decision, but it has consequences: the bone keeps shrinking and the options on the table narrow every year. The only advantage of this route is today's cost; the price is added on to the later plan.

Relining or replacing the denture

A new denture gives back the length of the teeth and the lip support; the collapse is pulled together in appearance, and you feel the difference on the first day. But a denture does not pass the load to the bone; it puts it on the tissue above. Because the bone loss underneath continues, the same gap opens up again a few years later, and the time each relining buys gets shorter. A denture buys time; it does not turn the process around.

Fillers and facial aesthetic treatments

Fillers in the lips and the corners of the mouth fill the groove on the surface. Because they do not touch the lack of bone underneath, their effect is both limited and temporary; as the bone keeps shrinking, the same treatment is needed more often. In a face whose problem is in the skeleton, the solution is not to be found in the skin.

Bone graft

Adding bone to the area that has shrunk is an attempt to make up the lost volume. It means additional surgery, additional cost and months of waiting. In the protocol we use, a graft does not come into it; because we place the implant in hard bone that is already in place, there is no need to regenerate the missing volume.

Fixed teeth on implants

This is the only solution that puts the load back inside the bone. The implant takes over the job the root left behind; because the bone is loaded again, the cause of the bone loss is removed. At the same time, fixed teeth rebuild lower face height and lip support. This is where it differs from a denture: it does this not by pressing down on the gum but by anchoring in the jaw itself.

What happens if it is put off

We write these not to frighten you but so that you can ask the right questions whichever dentist you go to. If a dentist does not tell you these things of their own accord, ask.

Bone that has shrunk does not come back

Alveolar bone that has been lost does not renew itself. This is the only irreversible point on this page, and it determines all the others. The bone you have today is the most bone you will ever have for this.

The options narrow every year

As the remaining height decreases, the floor of the sinus in the upper jaw and the nerve canal in the lower jaw come closer. A picture that can be solved today with a few implants and in a single stage needs, as the bone goes, more implants, a longer bridge and more complex planning; beyond a certain point, finding the hard bone for an implant to lock into also becomes harder. The decision to put it off comes back as surgical scope and time to be paid later.

As bite height drops, the jaw joint comes under strain

When lower face height decreases, the jaw joint and the chewing muscles start working in a position they are not used to. A tired jaw in the morning, pain that spreads to the ear and a noise when you open your mouth can come with this picture. However, bite height alone is not the cause of jaw joint complaints; for these complaints, reversible, conservative approaches are tried first. We do not treat a jaw joint complaint as a reason to rebuild the bite either; we assess the two separately.

A crack at the corner of the mouth that does not heal

In the corner where the lips fold over each other, the skin stays constantly moist; a sore forms there that cracks, scabs over and opens up again. The sore itself is often caused by fungi or bacteria and needs separate treatment by a dentist; your iron, B12 and blood sugar levels should also be checked. Dealing with it with creams alone is not enough, because as long as the loss of height that creates the fold is still there, the sore is liable to keep coming back.

Speech and diet change quietly

As lip support decreases, some sounds become distorted and the tone of the voice changes. In the same process, hard and fibrous foods drop off the menu, and the diet shifts towards soft, carbohydrate-heavy food. Because both changes are slow, they go unnoticed; this narrowing of what is on your plate sets the stage for weight and digestive complaints. Even so, do not put unexplained weight loss or ongoing digestive complaints down to your teeth alone; have your GP assess them separately.

Avoiding your own face

People stop having their photo taken, raise a hand to their mouth when they smile and keep the camera off on video calls. It is the loss patients mention last but that bothers them most, and it does not come up on its own at the examination. Tell us; it has a direct effect on the plan.

What to expect afterwards

The course below applies to the path in which facial height is rebuilt with fixed teeth. When only the denture is replaced, the process is shorter and the result is limited to appearance.

Planning and approval
The length of the teeth, the midline and the lower face height are planned from your facial measurements. The try-ins take place within the three clinical days, and that is where you see in the mirror how much lip support comes back; the final teeth are not fixed until you have given your approval.
Three clinical days
In the protocol we use, the implants lock mechanically into the hard basal and cortical layer deep in the jaw. A conventional implant, by contrast, is placed in the alveolar bone at the top, which shrinks along with the teeth; that is why it needs months of waiting for fusion and, if there is no volume left, adding bone first. This is where the difference comes from. Adding bone and months of waiting do not come into it, and at the end of three clinical days you leave with your final fixed teeth.
The first week
Some swelling and tenderness are normal and ease after the third day; any stitches are removed according to the clinic's follow-up plan. During this period we ask you to stick to soft food. The change in your face is there from the first day, and the lines become clearer as the swelling goes down.
The first months
While the lip and cheek muscles get used to the new support, speech and smiling settle within a few weeks. The change the people around you notice starts from the first day; getting used to it in the mirror takes you longer. Because the bone starts carrying a load again, the bone loss in that area loses its cause. Care is no different from natural teeth: brushing, interdental cleaning and regular check-ups.

Message us right away if

A sore at the corner of your mouth that has not healed in two weeks. Once the bite height has been corrected, that corner should recover. A sore that does not heal is assessed separately; call without waiting for your appointment.
A sore or hard area under your denture that does not go away. A sore that lasts longer than three weeks even though the edge has been adjusted needs to be examined for causes unrelated to the denture. Do not keep forcing the denture in.
Locking or increasing pain in your jaw joint. If catching or locking when you open your mouth, or pain that spreads to the ear, has increased, the bite should be reassessed. Do not leave this until your next check-up.

What determines the cost

We do not give a single figure on this page: pulling the facial features back together may end with a new denture or extend to a fixed plan covering the whole mouth, and the difference between the two is large. We give you the right figure after seeing the CBCT scan. Send us your X-ray and we will share the scope in writing. The items that determine the price:

The state of the remaining bone: The measured height and thickness determine the number of implants and where they are placed. For a patient who decides while the bone is still there, the plan stays short; as the bone loss progresses, more work is needed for the same result.
How wide the scope is: Whether one jaw or both are being treated, and how many teeth are missing, have a direct effect. A plan built around a single tooth and a plan covering the whole mouth are costed separately.
Whether the bite height is to be rebuilt: If lower face height has been lost, the plan does not stop at filling the gaps; the bite is rebuilt. This is an item that increases both the laboratory work and the number of try-ins.
Bridgework: The material of the fixed teeth made on the implants and the laboratory work directly affect the total. We share the brand of the material we use in writing from the outset.

Frequently asked questions

Can facial features that have fallen in come back?

In appearance, yes. When the length of the teeth and lower face height are rebuilt, the lips get their support back, the groove at the corner of the mouth opens out and the face comes close to its proportions from before it shortened. The only thing that does not come back is the bone that has been lost. That is why getting the same result years later is harder and a bigger job.

Couldn't I just have fillers?

A filler fills the groove under the skin, not the height the jaw has lost. As long as the support behind the lips is missing, the result stays on the surface and the treatment has to be repeated. Because the bone keeps shrinking, the gap between the two widens every year. A loss in the skeleton is not made up for in the skin.

I wear a denture. Will my bone still shrink?

It will. A denture does not pass the chewing load to the bone but puts it on the thin gum tissue over it, and this pressure does not stop the bone loss; it speeds it up. Your denture developing a gap every few years and needing to be relined is a sign of the same process. A denture pulls the appearance together; it does not protect the foundation.

I have just had a tooth taken out. When should I act?

Bone loss is fastest in the months after the extraction; the most valuable time is now. When the gap is filled early, the bone takes the load back and the cause of the bone loss is removed. Waiting a year means losing volume that will not be regained.

My bone has shrunk a lot and I was told I cannot have implants.

That answer comes from how a conventional implant works: a conventional implant is placed in the alveolar bone at the top, which shrinks along with the teeth; when there is no volume left there, bone has to be added first. The strategic implant we use, on the other hand, locks mechanically into the hard basal and cortical layer deeper down, which the bone loss does not reach. Send us your X-ray, and we will write to you about what can be done with the bone you have left.

I have lost one tooth. Will my face fall in?

With a single-tooth gap, the bone loss stays in a narrow area and does not show in the facial features; the neighbouring teeth carry on loading their own bone. The real issue here is not appearance but the neighbouring teeth tipping into the gap and the tooth from the opposite jaw growing into the space. Also, our protocol is for the full mouth or many missing teeth; for a single tooth, carrying on with your own dentist is enough.

I have diabetes. What changes for me?

We provide implant treatment for people with diabetes; what matters is not the condition itself but whether your blood sugar is under control. If it is uncontrolled, bone loss progresses faster and healing slows down. In that case we first ask you to get your levels in order with the doctor who manages your diabetes. The same applies to smoking.

Sources

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Next step

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