Facial Aging Process Research Articles

Does the Eyebrow Sag with Aging? An Anthopometric Study of 95 Caucasians from 20 to 79 Years of Age.

It is commonly assumed that a progressive sagging of the eyebrow occurs with the facial aging process. Only a few studies have analyzed this modification, and the findings are disparate and inconclusive. This study, based on reproducible and validated data, aimed to quantify the modifications of eyebrow position that may occur with aging. Also analyzed were the effects of these eyebrow position changes on the upper eyelid and on frontal muscle activity. The study included 95 Caucasian adults divided in three groups: 20 to 39, 40 to 59, and 60 to 79 years of age. Photographic portraits were made using a standardized photograph protocol. Eyebrow position was evaluated from the intercanthal line to four points along the upper margin of the eyebrow. The upper eyelid height, the lid sulcus height, and the upper iris coverage were measured. Severity of the forehead lines was analyzed using a validated scale. Reliability and validity of all measures were controlled beforehand. No significant differences were found when comparing eyebrow height above the medial canthus, the pupil, the lateral sclero-corneal limbus, and the lateral canthus between groups (p > 0.5). In addition, results suggested an increase of dermatochalasis when eyebrow height decreased. Also demonstrated was a significant increase of frontal muscle activity with aging. In contrast to conventional descriptions, this study demonstrated the stability of the eyebrow position with aging. This results from a physiological state of muscular compensation and may help explain the questionable results of eyebrow surgery.

Subperiosteal Midface-Lift

The subperiosteal midface-lift has benefited from significant technological advances in medicine. The endoscope now allows extensive subperiosteal undermining of facial soft tissue through minimal access incisions. Improved understanding of facial anatomy and the facial aging process now allow repositioning and remodeling of the soft tissue envelope with excellent aesthetic results. The subperiosteal midface-lift by a temporal approach is a procedure designed to rejuvenate the middle third of the face. After subperiosteal detachment, the soft tissues of the cheek, jowls, lateral canthus, and inferior orbital rim can be lifted to reestablish their youthful relationship with the underlying skeleton. It is a technique that produces satisfactory cosmetic results in most cases, causing malar augmentation, nasolabial fold improvement, and mild jowl improvement. We describe our preferred technique in detail and discuss its indications, complications, advantages, and limitations.

A Novel Approach to Structural Facial Volume Replacement

Improved understanding of the anatomy and physiology of the aging face has laid the foundation for adopting an earlier and more comprehensive approach to facial rejuvenation, shifting the focus from individual wrinkle treatment and lift procedures to a holistic paradigm that considers the entire face and its structural framework. This article presents an overview of a comprehensive method to address facial aging. The key components to the reported strategy for improving facial cosmesis include, in addition to augmentation of volume loss, protection with sunscreens and antioxidants; promotion of epidermal cell turnover with techniques such as superficial chemical peels; microlaser peels and microdermabrasion; collagen stimulation and remodeling via light, ultrasound, or radiofrequency (RF)-based methods; and muscle control with botulinum toxin. For the treatment of wrinkles and for the augmentation of pan-facial dermal lipoatrophy, several types of fillers and volumizers including hyaluronic acid (HA), autologous fat, and calcium hydroxylapatite (CaHA) or injectable poly-L-lactic acid (PLLA) are available. A novel bimodal, trivector technique to restore structural facial volume loss that combines supraperiosteal depot injections of volume-depleted fat pads and dermal/subcutaneous injections for panfacial lipoatrophy with PLLA is presented. The combination of treatments with fillers; toxins; light-, sound-, and RF-based technologies; and surgical procedures may help to forestall the facial aging process and provide more natural results than are possible with any of these techniques alone. This 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 .

Facial age estimation based on label-sensitive learning and age-oriented regression

This paper provides a new age estimation approach, which distinguishes itself with the following three contributions. First, we combine distance metric learning and dimensionality reduction to better explore the connections between facial features and age labels. Second, to exploit the intrinsic ordinal relationship among human ages and overcome the potential data imbalance problem, a label-sensitive concept and several imbalance treatments are introduced in the system training phase. Finally, an age-oriented local regression is presented to capture the complicated facial aging process for age determination. The simulation results show that our approach achieves the lowest estimation error against existing methods.

Techniques for the Optimization of Facial and Nonfacial Volumization with Injectable Poly-l-lactic Acid

With the recognition of the key role of volume loss in the facial aging process, injectable dermal fillers and volumizers have become increasingly important treatment options for recontouring and rejuvenating the aging face. While replacement fillers effectively correct individual lines and wrinkles, volumizing agents that replace collagen provide a longer-lasting, volume-based alternative. Poly-L-lactic acid (PLLA) has been shown to increase dermal thickness and volume for up to 2 years and beyond. Although early clinical use of this agent in patients with HIV-associated facial lipoatrophy was associated with a significant rate of nodule or papule formation, subsequent experience has helped define the proper reconstitution volumes and injection techniques for optimizing results and minimizing nodule/papule formation. While injectable PLLA has been used successfully for rejuvenation of most facial areas, increasing experience suggests that it is a versatile agent capable of providing aesthetic enhancement in multiple areas of the body, including the dorsum of the hands, the décolleté, the neck, the buttocks, the medial ankles, and acne scars. Although the current published experience in these areas is limited, further studies and clinical use of injectable PLLA will clarify the potential of this agent as a minimally invasive alternative and/or adjunct to surgery for restoring volume loss in multiple anatomic areas. This journal requires that authors assign a level of evidence to each article.

Mechanotransduction: The Missing Link in the Facial Aging Puzzle?

Craniofacial bony remodeling has been recognized as an important contributor to the facial aging process. Multiple studies have demonstrated significant craniofacial skeletal changes with age. However, no review has assembled this information in a concise, cogent fashion. Furthermore, the etiology of these skeletal changes has not been elucidated. This information is important for understanding the mechanisms of facial aging and for further development of facial rejuvenation. A literature review of all articles discussing remodeling of the craniofacial skeleton with age was performed. Studies that used objective measurements of craniofacial skeletal parameters for different age groups were collected and analyzed. The studies demonstrated consistent morphologic changes in the craniofacial skeleton with age. These changes included trends toward increased facial bony width in women; contour changes of the orbit, anterior maxilla, and mandibular body; and decreased dimensions of the glabellar, pyriform, and maxillary angles. The craniofacial skeleton remodels with aging. Many of the observed changes in soft tissue contour and position reflect these skeletal changes. Changes in facial muscle function through the process of mechanotransduction may be responsible for these skeletal changes.

Volume loss versus gravity: new concepts in facial aging

The earliest techniques of facial rejuvenation have been continuously adapted to reflect changes in the understanding of the aging face. Significant, paradigm-shifting advances in this understanding have been made in recent years which have allowed application of specific therapeutic modalities, resulting in dramatically improved results over those achieved with traditional facial rejuvenation. Pioneering work by several authors has shown that gravity is not the sole determinant of the aging face. These authors have demonstrated that volume loss, including that of soft tissue and bone, is at least equally important in the pathogenesis of the stigmata of aging. Rejuvenative techniques developed to reverse these atrophic changes have exhibited outstanding results. The consequence is an increasing emphasis on the use of volume restoration procedures to address the aging face. Recent improvements in the understanding of the facial aging process have brought about newly refined techniques for facial rejuvenation, ushering in a new era of plastic surgery for the aging face which is being manifested by increasingly natural results.