Facial Aging Process Research Articles

The Experience in Lower Eyelid Blepharoplasty: Improvement of Surgical Procedures Based on Anatomical Basis.

This study characterizes the appearance changes associated with aging of the human lower eyelid, grounded in its anatomical basis. Tailored approaches to lower eyelid bag are performed by these anatomical manifestations. From January 2017 to January 2023, lower eyelid blepharoplasty was performed on 137 patients, aged 20 to 60 years. These patients were divided into 3 groups according to the periorbital aging appearance, primarily characterized by the presence and location of the "bag" bulge of the lower eyelid. We analyzed the corresponding changes in anatomical structures for each type, which included a weakened fibrous orbital support system, reduced muscle tone, and increased orbital fat. Patients were treated with tailored blepharoplasty techniques according to their classification. All patients in this study ranged in follow-up from 1 to 12 months. With patients' permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome. Our study identified 3 morphologies of the lower eyelid. Type 1 presents a "bubble bag" in the medial and inferior aspect of the lower eyelid. Type 2 features a double convexity contour, with separate fat pad herniations demarcated by fibrous connective tissue. Type 3 exhibits a single convexity with a uniform herniation of fat pads across the entire lower eyelid. We have delineated the anatomical changes associated with each morphology type. With an approach grounded in "remodeling" and "recovery," the surgical treatment targets the fibrous support tissue to improve the outcomes of lower eyelid rejuvenation. No complications occurred. All postoperative results reached both surgeon's and patient's expectations. Surgeons must recognize the pivotal role of fibrous connective tissues-including the arcuate expansion, fascia of the inferior oblique muscle, and the orbicularis retaining ligament-and endeavor to preserve or reinforce these structures during surgical procedures. An anatomically based surgical approach would more effectively and safely to resist the facial aging process.

Profhilo® Structura, Current Status and Future Perspectives: A Practical Review.

Hyaluronic acid (HA)-based injectables continue to grow in popularity and are used worldwide to improve facial changes associated with aging. Profhilo® Structura (IBSA Farmaceutici Italia, Lodi, Italy) is a novel HA-based product that uses nano hybrid complex of hyaluronic acid (NAHYCO)® technology to create hybrid cooperative complexes consisting of high and low molecular weight HA. Profhilo® Structura's high concentration (45 mg of total HA) and rheological properties (ie, viscosity [resistance to flow] and elasticity [stickiness]) have been specially formulated to restore facial adipose tissue. Because of their early involvement in the facial aging process, the superficial medial and lateral-temporal cheek fat compartments are good candidates for treatment. However, recommendations and guidelines are necessary to ensure that treatment is safe and effective. Three experts were invited to IBSA Farmaceutici Italia Srl to discuss clinical rationale, optimal injection techniques, and clinical outcomes for treating the superficial medial and lateral-temporal cheek fat compartments with Profhilo® Structura. These techniques were developed using patients presenting with either initial hypotrophy of fat compartments within the preauricular area (ie, sinkers) or jowl sagging due to hypotrophy within the preauricular and zygomatic areas (ie, saggers). Targeting these areas using the optimal injection site can maximize product diffusion and minimize the risk for vascular compromise. Targeting these areas also leads to lateral tightening and lipolifting effects due to adipose tissue restoration. The experts agreed that Profhilo® Structura is currently the first and only HA-based injectable treatment that can integrate and restore the adipose tissue in these affected fat compartments.

An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique

BackgroundThe facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse PlusTM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse DuoTM. Herein, we present cases that illustrate the use of this approach.MethodsThis pilot study enrolled 36 participants (33 women and three men; ages 37–68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment.ResultsTreatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume.ConclusionsThe V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse PlusTM for restructuring and retaining ligaments and Radiesse DuoTM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

SUBCUTANEOUS FILLING OF TEAR DROP IN THE LOWER EYELID

The tear drip, medial portion of the lower part of the orbital cavity, presents a deformity of multifactorial origin, not only affecting patients in the facial aging process. One treatment possibility is to use fillers with specific flexibility characteristics for this region. When applying this technique, we deposit microdots in the subcutaneous tissue throughout the peri-orbicularis oculi region from the medial canthal ligament to the lateral canthal ligament. Approximately 0.4 ml was used on each side (right and left) distributed in application micropoints using the smart click syringe system throughout the lower eyelid in superficial and deeper points of the same subcutaneous layer so as not to concentrate the product under the skin. We chose not to perform overcorrection, since the product used by your Swelling Factor could, over the days, after absorbing water, form pockets in the treated region. The present descriptive observational study aimed to highlight the results of subcutaneous filling with Vital Light Skinboosters in the treatment of tear leakage.

USE OF BOTULINUM TOXIN TYPE A (BOTOX) AND ITS AESTHETIC BENEFITS

The skin is the most external organ responsible for protecting the innermost layers of the body, protecting it against thermal agents, climate change and other organic defenses in relation to the environment. Human development is marked by several natural processes within the body itself, however, skin aging is a factor that occurs intrinsically or extrinsically, leaving the appearance of wrinkles and expression lines visible. The use of botulinum toxin type A (TBA or Botox) has been carefully used for aesthetic purposes in the treatment of discomfort resulting from facial skin aging. The present study aimed to present the aesthetic benefits of using botulinum toxin - Botox. This is an integrative review of the literature using the National Library of Medicine (PubMed) and Virtual Health Library (VHL) databases with the search for articles using the descriptors “botulinum toxin”; “aesthetics” and “facial aging” registered in DeCS with the help of the boolean operator and. The selection of articles was carried out using the inclusion criteria where articles from the last five were selected, in Portuguese or foreign language and which were correlated with the main theme of the research. For the exclusion criteria, articles that were not consistent with the theme and duplicate articles were excluded by title or abstract. Thus, the present study aimed to achieve the objectives described through literature review analysis, where it was possible to verify the effectiveness and benefits of TBA in the facial aging process. Furthermore, it was possible to enable scientific research as a development for further studies in the area of aesthetics in general and contributing to a greater collection of knowledge.

Age-Related Changes of the Zygomatic Ligament: An Experimental Animal Study.

Facial aging is a multifactorial process involving the skin, fat, muscles, bones, and ligaments. The role of facial ligaments in the facial aging process remains elusive. The aim of this study was to identify whether age-related changes in facial ligaments exist and how to best quantify such changes when investigating the zygomatic ligament in the rat. A total of 30 male Sprague-Dawley rats (10 young, 10 middle-aged, 10 mature) were investigated to visualize the zygomatic ligament. Samples of the ligaments spanning the zygomatic arch and the skin were taken and histologically examined with hematoxylin-eosin, Masson, Verhoeff's elastic, and picrosirius red staining. Quantification of the Type I/III collagen ratio and collagen content was performed by color deconvolution and electron microscopic imaging. With increasing age, collagen fibers inside of the examined ligaments appeared thicker and more closely arranged. The Type I/III collagen ratio was measured to be 1.74 in young animals, 3.93 in middle-aged animals, and 5.58 in mature animals. The ultra-microstructure of the ligament was less coordinated in direction and orientation in young and middle-aged animals than in mature animals, in which collagen fibers were bundled together in a strong and oriented mesh. Ligaments appeared thinner, transparent, more elastic, and less robust in young animals, whereas ligaments in mature animals appeared thicker, more fascia-like, less elastic, and more robust. An increase in the Type I/III collagen ratio, indicating greater stiffness and reduced elasticity, was observed with higher age of the investigated animals. These findings indicate that ligaments might increase in stiffness and rigidity with age.

Oral Region Myomodulation and Skin Rejuvenation With Polydioxanone Threads and Hyaluronic Acid Filler: Cross-Filler Technique

The facial aging process is progressive, and rejuvenation of the oral region is challenging, as the skin alterations also reflect the changes in the fat, muscles, ligaments, and bone. Therefore, the procedures for improving this region must be combined to optimize the result. The use of polydioxanone (PDO) threads has been increasing in cosmetic dermatology in the last few years. Different types of threads, barbed, molded, non-barbed, straight, screwed, filler, etc., are available in the market bringing new options for treatment. Here, we want to present a new technique using a particular type of PDO thread, called solid filler thread, which was developed to fill folds in the face, replacing hyaluronic acid (HA) gel in some cases. Based on its purpose, it could also act as HA filler for myomodulation with the advantage of not promoting volume next to modiolus. In our technique, we associated HA filler gel in the areas where volume was desired, such as lips and mental area. We will report some cases to illustrate our technique and show the improvement in static and dynamic wrinkles, restructuring the oral region.

Alloplastic Facial Implants

AbstractAs the face ages, there is thinning of the epidermis, volume loss and rearrangement of the soft tissues, and malabsorption of the skeletal framework. It is essential to have a thorough understanding of the aging process for successful facial augmentation and rejuvenation. Alloplastic implants can be used to provide a long-lasting solution for augmentation of skeletal deficiencies, restoration of facial irregularities, and rejuvenation of the face. In this study, we describe the ideal implant characteristics along with the advantages and disadvantages of various implant materials. We also present techniques in nasal and premaxillary augmentation, midface augmentation, mandibular augmentation, and lip augmentation. Additionally, computer-aided design and manufacturing as well as bioprinting are emerging technologies with growing applications in facial plastic and reconstructive surgery. We discuss their role in the creation of patient-specific custom implants. The overall goal of facial rejuvenation is to address multiple aspects of the facial aging process including deficiencies in the skin, soft tissues, and skeletal framework. The use of alloplastic implants alone or synergistically with additional surgical procedures can restore a wide range of anatomical deficits that occur with age.

Inbetweening auto-animation via Fokker-Planck dynamics and thresholding

<p style='text-indent:20px;'>We propose an equilibrium-driven deformation algorithm (EDDA) to simulate the inbetweening transformations starting from an initial image to an equilibrium image, which covers images varying from a greyscale type to a colorful type on planes or manifolds. The algorithm is based on the Fokker-Planck dynamics on manifold, which automatically incorporates the manifold structure suggested by dataset and satisfies positivity, unconditional stability, mass conservation law and exponentially convergence. The thresholding scheme is adapted for the sharp interface dynamics and is used to achieve the finite time convergence. Using EDDA, three challenging examples, (I) facial aging process, (II) coronavirus disease 2019 (COVID-19) pneumonia invading/fading process, and (III) continental evolution process are computed efficiently.</p>

A Survey on Deep Learning Face Age Estimation Model: Method and Ethnicity

Face age estimation is a type of study in computer vision and pattern recognition. Designing an age estimation or classification model requires data as training samples for the machine to learn. Deep learning method has improved estimation accuracy and the number of deep learning age estimation models developed. Furthermore, numerous datasets availability is making the method an increasingly attractive approach. However, face age databases mostly have limited ethnic subjects, only one or two ethnicities and may result in ethnic bias during age estimation, thus impeding progress in understanding face age estimation. This paper reviewed available face age databases, deep learning age estimation models, and discussed issues related to ethnicity when estimating age. The review revealed changes in deep learning architectural designs from 2015 to 2020, frequently used face databases, and the number of different ethnicities considered. Although model performance has improved, the widespread use of specific few multi-races databases, such as the MORPH and FG-NET databases, suggests that most age estimation studies are biased against non-Caucasians/non-white subjects. Two primary reasons for face age research’s failure to further discover and understand ethnic traits effects on a person’s facial aging process: lack of multi-race databases and ethnic traits exclusion. Additionally, this study presented a framework for accounting ethnic in face age estimation research and several suggestions on collecting and expanding multi-race databases. The given framework and suggestions are also applicable for other secondary factors (e.g. gender) that affect face age progression and may help further improve future face age estimation research.

Thread Lifting of the Jawline: A Pilot Study for Quantitative Evaluation.

Introduction:The facial aging process produces changes that are characteristic of the superficial and deep fat framework and skin layers. Subdermal suspension with threads enables the sagging tissues to be lifted by means of a minimally invasive, closed procedure without surgical dissection. This observational study has been carried out on the basis of standardized tridimensional photographic analysis and measurement, aimed at determining objective, repetitive, and reliable evaluation of the soft tissue suspension technique.Materials and Methods:Eight participants were enrolled in this pilot study presenting with mild to moderate ptosis of the jawline tissues. Patient photographs were taken before (t0), immediately after threads implantation (t1), and at the following visit (t2). Each image captured before thread insertion was registered by the software and surface linear lengths in between the mentioned points were calculated.Results:The result showed an overall average improvement in the “tragus-to-marionette distance” (C-A) and the “tragus-to-jowl distance” after a mean follow-up time of 8.16 months (t0-t2). All analyzed parameters improved significantly (P < 0.05) at t1 and at t2 with respect to t0.Conclusions:This pilot study suggest that facial tissue suspension by means of poli-lactic/poli-caprolactone threads is safe and effective in treating skin flaws that affect mild-to-moderate ptosis of the jawline up to 8 months.

Using injectable fillers for midface rejuvenation

Treatment aimed at preventing and reversing the facial aging process has grown in popularity. The aging midface is defined by classic deepening of the nasolabial folds, formation of marionette lines around the mouth, and significant atrophy of deep facial fat. While surgical options have been investigated with satisfactory and long-lasting results, nonsurgical alternatives such as soft tissue fillers are a safe and effective strategy for facial rejuvenation. This review focuses on a variety of injectable fillers available for the treatment of the aging midface, including hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and polymethyl methacrylate. Mechanism of action, relevant anatomy, indications/contraindications, technique, and any evidence of efficacy and safety are described. The benefits of injectable fillers include reduced patient discomfort and shorter recovery times. Understanding the advantages and limitations of injectable fillers for midface augmentation can allow providers to counsel and treat patients seeking care appropriately.

The Facial Aging Process From the "Inside Out".

The normal course of aging alters the harmonious, symmetrical, and balanced facial features found in youth, not only impacting physical attractiveness but also influencing self-esteem and causing miscommunication of affect based on facial miscues. With this evidence-based paper, the authors aim to provide a comprehensive overview of the latest research on the etiology and progression of facial aging by explaining the aging process from the “inside out,” that is, from the bony platform to the skin envelope. A general overview of the changes occurring within each of the main layers of the facial anatomy is presented, including facial skeleton remodeling, fat pad atrophy or repositioning, changes in muscle tone and thickness, and weakening and thinning of the skin. This is followed by an in-depth analysis of specific aging regions by facial thirds (upper, middle, and lower thirds). This review may help aesthetic physicians in the interpretation of the aging process and in prioritizing and rationalizing treatment decisions to establish harmonious facial balance in younger patients or to restore balance lost with age in older patients.

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction.

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

Objective evaluation of the relationship between facial expression analysis by the facial action coding system (FACS) and CT/MRI analyses of the facial expression muscles.

There are few reports on the relationship between facial expression formation and mass of the muscle responsible for facial expression. We analyzed the facial expression using facial action coding system (FACS) and examined the muscle mass and characteristics of the facial expression muscles using multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI). Moreover, the relation between these was statistically evaluated. Ten healthy women in their 40s (43.4±3.0years, 40-49) were enrolled. The expressive faces were analyzed by facial expression analysis software based on the FACS. The muscle mass and characteristics of the facial expression muscles were investigated using MDCT/MRI. The correlation between an integrated expression intensity value (IEIV) for FACS of the widest possible grin and muscle mass was analyzed. The mean values between the two categorized groups (G-1 and G-2) based on fat infiltration into the muscle were compared. A positive correlation is found between the IEIV and the muscle mass. The IEIV of G-1 is significantly larger than the corresponding value of G-2. Hence, the results indicated that the subjects with high IEIV and expressive face had thicker facial expression muscles and little fat infiltration into the muscles. Our objective imaging diagnostic study using FACS, MDCT, and MRI corroborated the anti-aging medical science about the facial expression muscles related to youthful facial appearance. The results of this research could contribute to the elucidation of the mechanisms involved in the facial aging process and to the development of cosmetology.

Disentangled representation learning and residual GAN for age-invariant face verification

One of the challenges in cross-age face recognition and verification is to effectively model the facial aging process. Despite the rapid advances in face-related areas, it is still very difficult for existing methods to simultaneously achieve accurate facial feature preservation and reliable aging during aging modeling. Aiming to address this issue, we introduce a Disentangled Representation learning and Residual Generative Adversarial Network (DR-RGAN) that represents the facial features without age interference, which is achieved by explicitly disentangling the facial features and age variation. An encoder-decoder structured generator produces aging images from unstructured facial representations by using the age characteristics provided separately. It can thus take the disentangled representation to preserve personal identity for face verification. Considering that pixel-based errors may cause a loss of detail, a VGG based content loss is further equipped to preferably preserve facial features. The discriminator is trained to distinguish the real from generated faces, carry out identification prediction, and leverage an age estimator to boost the aging accuracy. It is beneficial for obtaining more photorealistic and desirable aging effects, as well as more consistent face verification results. Extensive experiments on the CACD and LFW datasets demonstrate that our DR-RGAN generates pleasing aging imageries and achieves a high accuracy of face verification.

Treating nasolabial folds with dermal fillers: a holistic approach

There are multiple surgical and non-surgical ways to treat the nasolabial fold. Traditionally, the non-surgical way of treating nasolabial folds was through careful placement of hyaluronic acid fillers directly to the fold. Our understanding of the facial ageing process and facial anatomy has enabled us to evolve our technique so that nasolabial fold treatments are safer for patients and deliver better clinical outcomes. By treating nasolabial folds indirectly, by addressing the changes that occur through aging, the aesthetic practitioner can achieve more natural and effective reduction in the fold. Indirect treatment of the nasolabial fold requires addressing the bony resorption, deep fat and superficial fat volume loss. Through better understanding of the facial aging process, we are entering an era where more practitioners are treating the cause of a particular line than treating it directly. This has the benefit of creating a more balanced and natural result with longer lasting rejuvenation.

Learning and Interpreting Features to Rank

Previously, it was taken for granted that features learned for classification can also be used for ranking. However, ranking problems possess some distinctive properties, e.g., the ordinal class labels, which indicates the necessity of developing new feature learning procedures dedicated for ranking. In this article, the authors propose to use a convolutional neural network (CNN)-based framework, ranking-CNN, for learning and interpreting features to rank. As a case study, the authors propose to analyze, visualize and work to understand the deep aging patterns in human facial images using ranking-CNN. The authors develop a visualization method that can compare the facial appearance and track its changes at different ages through the mapping between 2D images and a 3D face template. The framework provides an innovative way to understand the human facial aging process.

Demographic-Assisted Age-Invariant Face Recognition and Retrieval

Demographic estimation of human face images involves estimation of age group, gender, and race, which finds many applications, such as access control, forensics, and surveillance. Demographic estimation can help in designing such algorithms which lead to better understanding of the facial aging process and face recognition. Such a study has two parts—demographic estimation and subsequent face recognition and retrieval. In this paper, first we extract facial-asymmetry-based demographic informative features to estimate the age group, gender, and race of a given face image. The demographic features are then used to recognize and retrieve face images. Comparison of the demographic estimates from a state-of-the-art algorithm and the proposed approach is also presented. Experimental results on two longitudinal face datasets, the MORPH II and FERET, show that the proposed approach can compete the existing methods to recognize face images across aging variations.

The Application of Three-Dimensional Surface Imaging System in Plastic and Reconstructive Surgery.

Three-dimensional (3D) surface imaging system has gained popularity worldwide in clinical application. Unlike computed tomography and magnetic resonance imaging, it has the ability to capture 3D images with both shape and texture information. This feature has made it quite useful for plastic surgeons. This review article is mainly focusing on demonstrating the current status and analyzing the future of the application of 3D surface imaging systems in plastic and reconstructive surgery.Currently, 3D surface imaging system is mainly used in plastic and reconstructive surgery to help improve the reliability of surgical planning and assessing surgical outcome objectively. There have already been reports of its using on plastic and reconstructive surgery from head to toe. Studies on facial aging process, online applications development, and so on, have also been done through the use of 3D surface imaging system.Because different types of 3D surface imaging devices have their own advantages and disadvantages, a basic knowledge of their features is required and careful thought should be taken to choose the one that best fits a surgeon's demand.In the future, by integrating with other imaging tools and the 3D printing technology, 3D surface imaging system will play an important role in individualized surgical planning, implants production, meticulous surgical simulation, operative techniques training, and patient education.