Women with a lower waist-to-hip ratio (WHR) are consistently judged as more attractive, a finding replicated across diverse populations and methods. From an evolutionary perspective, this preference may reflect selection for cues of female reproductive potential, as WHR reliably tracks both age and parity. However, virtually all previous studies present nude or minimally clothed bodies in highly standardized conditions, leaving open whether WHR-based judgments generalize to more ecologically valid settings and whether they extend beyond attractiveness to the reproductive traits WHR is a cue of. We addressed both questions by analyzing 608 painted female figures from European portraits (1650-1950), depicting fully clothed women in visually complex and minimally sexualized settings. Online Prolific observers (N = 1,525) independently estimated the body shape, attractiveness, age, and likelihood of previous childbirth from either the body or the face of the painted characters. Perceived WHR strongly predicted all three trait judgments: lower WHR was associated with higher attractiveness, younger perceived age, and lower perceived likelihood of previous childbirth. These relationships persisted after controlling for posture, body orientation, perceived weight, perceived facial age, artistic school, and date of the artwork. Our findings show that WHR-based perceptual heuristics are not artefacts of the narrow stimulus conditions used in prior research but persist in visually complex, clothed, and historically diverse depictions of women. They further suggest that fashion styles that exaggerate WHR may have functioned as strategic amplifiers of reproductively relevant cues, with implications for theories of mate choice, social signaling, fashion history, and cultural evolution.

Biostimulatory injectables represent a transformative paradigm in aesthetic medicine, shifting the therapeutic focus from immediate volumization to biologically driven tissue regeneration. Unlike traditional hyaluronic acid fillers, agents such as calcium hydroxylapatite (CaHA) and poly-L-lactic acid (PLLA) harness the body's endogenous regenerative capacity by activating fibroblasts and promoting neocollagenesis. This chapter reviews the scientific foundations, mechanisms of action, clinical applications, and evolving role of these two principal biostimulatory agents. CaHA and PLLA exert their regenerative effects primarily within the dermis and subdermal connective tissue. Optimal outcomes require a precise injection technique within the subdermal plane, and treatment zones include the face, neck, décolletage, and body. CaHA microspheres provide immediate structural support while simultaneously functioning as a biologic scaffold for neocollagenesis. PLLA microparticles achieve their regenerative effect through gradual polymer hydrolysis and prolonged fibroblast stimulation, yielding cumulative and durable improvements across staged treatment sessions. Both PLLA and Hyperdilute CaHA formulations enable versatile treatment across multiple anatomic regions. Optimal outcomes depend on proper patient selection, appropriate dilution strategies, and precise injection technique within the subdermal plane. Thorough patient counseling regarding the delayed onset of results is essential to manage expectations. PLLA, in particular, requires staged treatment sessions to achieve cumulative improvements. Together, CaHA and PLLA offer clinicians a sophisticated, biologically grounded complement to the broader injectable armamentarium, addressing the underlying structural causes of facial aging rather than solely masking their clinical manifestations.

Facial hyperpigmentation is a primary marker of skin aging in Asian populations. While many artificial intelligence (AI)-based aging simulators exist on social media, they often lack scientific transparency and dermatological validation. This study introduces and validates a novel facial aging simulator specifically engineered to provide personalized, evidence-based predictions of pigmentary spot progression according to varying levels of ultraviolet (UV) exposure and photoprotection. The simulator utilizes a dual-tool framework: Elicitation Based Aging Simulator (EBAS) and AgingMapGAN (AMGAN). EBAS leverages the collective expertise of 28 dermatologists via a structured Delphi process and causal Bayesian belief networks (BBNs) to model skin aging trajectories. AMGAN, a conditional generative adversarial network, provides high-resolution visual representations of these trajectories. The model was trained on a standardized dataset of 600 individuals and focused on the density of pigmentary spots (DPS) on the cheek. Model performance was benchmarked against expert clinical grading using correlation metrics. The simulator demonstrated high accuracy in replicating expert logic (Pearson's correlation 0.96). In a case study of a 38-year-old female of Chinese descent, the model predicted the 15-year probability of a clinically significant progression (a two-grade increase in DPS). In the absence of photoprotection, the probability of reaching this elevated grade by age 53 was 71.35%, whereas regular daily application of SPF 50+ sunscreen reduced this probability to 39.24%. This framework represents the application of a scientifically validated image-generation tool for predicting age-related hyperpigmentation based on individual exposome factors. By integrating dermatological knowledge, this simulator provides a robust educational and research resource for personalized skincare strategies. The findings confirm that consistent photoprotection significantly mitigates the 15-year trajectory of premature facial aging, offering a scientifically validated foundation for public health communication on prevention.

BackgroundFacial skin aging is a complex, progressive process, but subtle and nonlinear changes during young adulthood remain insufficiently characterized. This study aimed to develop an early-aging atlas of facial skin in young Chinese women and to identify key age-related turning points among the various aging traits.MethodsA total of 500 Chinese female volunteers aged 18–33 years participated in this study. We assessed 45 physiological skin parameters associated with barrier function, color, texture, pigmentation, and wrinkles using various noninvasive skin assessment techniques. Beyond Pearson correlation analysis, we used locally weighted scatterplot smoothing (LOESS) to model how these skin parameters evolve with age, capturing any nonlinear patterns.ResultsAge-related facial changes were detectable even within this young cohort. Sebum secretion and skin elasticity declined with age, whereas pigmentation, roughness, and wrinkle-related parameters increased. LOESS analysis suggested several approximate age-related transition points. Around 22 years of age, skin dullness and latent UV damage appeared to increase. Around 25 years, periocular wrinkles and mid-face roughness became more evident. After 27 years, brown spots showed a more apparent upward trend. Around 29–30 years, skin elasticity showed a more marked decline, accompanied by a secondary decrease in sebum secretion. These LOESS-indicated transition periods should be interpreted as exploratory rather than mathematically confirmed thresholds.ConclusionEarly facial aging in young Chinese women follows asynchronous and nonlinear trajectories across different skin dimensions. The identified transition points before age 30 provide a quantitative basis for understanding the temporal progression of early facial aging and may support age-specific prevention and intervention strategies.

Lower facial aging is a dynamic process involving aging in the skin, fat compartments, and bony structures. Adopting appropriate methods to evaluate facial aging is important to clinical decision making. The aim of this study was to develop a method for evaluating lower facial aging pattern and to characterize age-related changes in the aging trajectory of the lower face using a combination of quantitative parameters. A total of 200 subjects were stratified by age and sex into 10 subgroups for analysis. Lower facial aging features were evaluated using a comprehensive approach that included the Jowl Appearance Scale (JAS) for the jowl area; quantitative measurements for the marionette lines (marionette line length, maximum color depth, and marionette line angle between the horizontal axis); and the prejowl sulcus appearance scale for the prejowl sulcus triangle. The JAS, the marionette lines grading scale, the marionette line length, the maximum color depth of marionette line, the marionette line angle, and the prejowl sulcus scale increased significantly with age for both male and female study populations. The correlation coefficients between age and the evaluated features were as follows: JAS (0.84), marionette line grading scale (0.81), marionette line length (0.86), maximum color depth (0.88), marionette line angle (0.90), and prejowl sulcus appearance scale (0.86). The findings demonstrate a progressive pattern of lower facial aging that is effectively captured by the combination of quantitative parameters and the newly established prejowl sulcus appearance scale. This methodology provides a practical tool for developing personalized treatment strategies and facilitating timely interventions. 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 .

Children born with fetal growth restriction (FGR) or small for gestational age (SGA) face an increased risk of motor and cognitive impairments, although prevalence and severity vary across studies due to differences in definitions, assessment methods, and population characteristics. In recent years, advances in technology and clinical awareness have led to a growing body of research on the relationship between fetal growth and neurodevelopmental outcomes. This mini-review synthesises recent findings on the impact of SGA and FGR on neurodevelopment in preterm and term infants across the lifespan. Three databases were screened to identify original studies published between 2020 and 2025 with 40 studies meeting the selection criteria. Evidence suggests that children born SGA or with FGR are at higher risk of cognitive impairments, which may persist into later life; however, results from some preterm cohorts do not show significant associations. Findings on sensory and behavioural outcomes are limited and heterogeneous, reflecting the fewer studies that have addressed these domains. Regarding motor outcomes, reports on cerebral palsy remain inconsistent, with some studies suggesting no increased risk. In contrast, broader evaluations of motor function consistently indicate a higher prevalence, particularly among term-born cohorts. Together, these findings highlight the need for refined definitions, standardised assessment tools, and longitudinal studies to clarify the developmental trajectories of children born with growth complications and to guide early interventions.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed metabolic care but are increasingly associated with rapid, region-specific facial volume loss, commonly referred to as "Ozempic face." Current literature remains descriptive and largely focused on late-stage correction. To propose a conceptual, anatomy-driven framework for early identification and prevention of GLP-1 RAs-associated facial aging. This manuscript presents a hypothesis-generating model developed through integration of facial aging biomechanics, emerging literature on GLP-1 RAs-associated changes, and clinical pattern recognition. We introduce a risk-stratification model based on anatomical phenotype and a four-phase conceptual prevention algorithm aligned with weight-loss kinetics. The framework incorporates early intervention strategies, clinical "off-ramps," and patient-specific modifiers to guide anticipatory management. This conceptual model proposes a shift from reactive correction to preventive, anatomy-based management of GLP-1 RAs-associated facial changes. Future studies are needed to validate and refine this framework. 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 .

Midface lifting remains a challenge for plastic surgeons in facial rejuvenation. Midface drooping is a common problem in facial aging. However, limited by the complexity of the midface anatomy, the outcomes of the traditional midface lifting technique through the lower blepharoplasty incisions were not desirable enough. Meanwhile, the rhytidectomy surgery brought enormous trauma and had a limited effect on the lifting of the midfacial soft tissues. To improve postoperative outcomes and reduce trauma, we proposed a novel, reliable technique to suspend the midface in a double-plane manner and share our experience in this article. The final outcomes indicate the efficiency of our technique.

The face you're born with: How early development dictates a lifetime of expression and ageing.

The absurdist approach to unveiling possible paradoxical thinking for innovative socio-psychological research.

Overcoming occlusions in the wild: A multi-task age head approach to age estimation

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) exert systemic metabolic and anti-inflammatory effects that may be relevant to cellular senescence, a key driver of skin aging. However, human cutaneous data are lacking. To explore whether systemic GLP-1RA therapy translates to a detectable reduction in cutaneous senescence, quantified by epidermal p21 expression and supported by AI-driven facial imaging. In this controlled observational pilot study, 3 male adults (GLP-1RA n = 2; GLP-1RA-naïve control n = 1) underwent 3-mm punch biopsies from a standardized, sun-protected gluteal site to isolate intrinsic aging. Senescence was quantified through blinded whole-epidermis digital annotation of p21-positive nuclei. Clinical phenotypes were assessed using noninvasive cheek measurements and AI-based facial age estimation. The cohort demonstrated divergence in senescence-associated biomarkers correlating with GLP-1RA exposure. The GLP-1RA-naïve control exhibited 8.0% (n = 2,062 nuclei) epidermal senescence. By contrast, participants with 163 and 62 days of GLP-1RA exposure showed reduced senescence burdens of 2.4% (n = 2,045) and 0.6% (n = 1,636), respectively. Automated facial age estimation remained concordant with chronological age across subjects. Systemic GLP-1RA exposure is associated with a substantial reduction in epidermal p21 expression in some subjects, suggesting a senomorphic effect and supporting further mechanistic studies at the interface of metabolic regulation and skin aging.

Autologous fibroblast therapy for facial rejuvenation: A randomized open-label controlled study

Francisco Goya's Time and the Old Women (Las Viejas, c. 1810-1812) portrays aging, vanity, and the inescapable presence of time through the image of elaborately dressed elderly women overshadowed by the winged figure of Time. This editorial uses the painting as a lens through which to examine modern craniofacial and aesthetic practice. The face uniquely combines anatomy with identity, making age-related change both biologically visible and psychologically meaningful. Contemporary surgeons possess increasingly sophisticated tools to modify facial aging, yet technical intervention cannot eliminate the temporal processes of tissue change, healing, and mortality. Patient motivations range from functional impairment and restoration of dignity to unrealistic expectations rooted in body image distress or social comparison. Accordingly, the surgeon's role extends beyond operative skill to judgment, ethical discernment, and candid communication. Goya's painting reminds clinicians that every facial consultation occurs in the presence of time. Whether reconstructive or aesthetic, treatment of the face requires balancing anatomic possibility with psychological reality and human vulnerability.

Glucagon-like peptide-1 (GLP-1) receptor agonists have transformed medical weight-loss therapy and have been associated with characteristic facial changes, including hollowing, skin laxity, and contour alterations that may accentuate pre-existing signs of aging. To review the anatomical basis of facial changes after GLP-1-associated weight loss and provide an evidence-based rationale for injectable aesthetic treatment using collagen-stimulating agents and hyaluronic acid (HA) fillers. A narrative review was conducted focusing on region-specific facial aging anatomy, fat-compartment behavior, skeletal remodeling, soft-tissue mechanics, and skin changes associated with rapid weight loss. These findings were integrated with current international consensus recommendations for patients undergoing medication-derived weight loss. Facial changes after medical weight loss involve multiple structural layers, including deflation of superficial fat compartments, loss of deep support, skeletal resorption, and increased skin laxity. Midfacial volume loss seems to occur mainly in superficial fat compartments, contributing to contour flattening and more pronounced transition lines. These changes support a treatment strategy combining early collagen stimulation with targeted HA filler placement to address tissue quality, support, and volume loss. Effective management of the medical weight-loss face requires an anatomically informed, multimodal approach using early biostimulation and selective HA-based structural restoration.

Maternal Mortality and Cardio-Kidney-Metabolic Risk Factors Across High-Income Countries.

Personalized face aging via counterfactual-guided appearance manipulation

With the integration of artificial intelligence (AI) into various medical specialties, its role in aesthetic surgery is rapidly gaining traction for diagnostic, educational, and therapeutic applications. Depression, a condition known to accelerate facial aging, presents a novel intersection for AI and psychiatry within cosmetic practice. This study aimed to evaluate the accuracy and clinical relevance of generative AI models in describing and visualizing facial features of depressed medical residents. We employed advanced large language models (LLMs) and generative adversarial networks (GANs), including ChatGPT-models, Gemini, Midjourney, LeonardoAI, and others, to generate descriptive texts and hyperrealistic images of "depressed medical residents." Three experienced plastic surgeons and three psychiatrists assessed the outputs using customized 7- and 8-parameter Likert scales, scoring the clarity, realism, emotional nuance, resemblance to clinical cases, and overall utility. To reduce bias, all experts were blinded to the identity of the AI models that produced each output. Psychiatrists generally rated the models higher than plastic surgeons, with ChatGPT-4o receiving the highest score among LLMs. Among GANs, BlueWillow V5 and Stable Diffusion Ultra were preferred by psychiatrists and plastic surgeons, respectively. Discrepancies in scoring reflect differing clinical priorities-emotional cues for psychiatrists versus anatomical aging markers for surgeons. AI-generated imagery and descriptions demonstrate potential in bridging aesthetic medicine and mental health education. These tools can enhance physician awareness, clinical training, and diagnostic understanding of depression-related facial aging, especially among vulnerable populations like medical trainees. 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 .

Despite the remarkable progress being made in the study of human facial age estimation, it is still a challenging problem. The main problem lies in the large intra-age appearance variations among different individuals. Sometimes, these variations can even exceed the inter-age appearance variations of the same individual. To address this problem, we construct a cross-identity image sequence for each query image and reformulate age estimation as a multi-image learning task. This provides a basis for learning common age-related cues across identities. Based on this formulation, we propose the Cross-Identity Interaction Transformer (CIIT) for age estimation. The CIIT first extracts multi-scale aging cues through a cross-scale embedding (CSE) module to preserve age evidence from fine textures to coarse structural changes. Secondly, to progressively enhance facial features and capture shared facial characteristics from cross-identity references, intra-image feature attention (IFA) and prior-guided axial cross-image attention (PG-ACIA) operate alternately within each Transformer block. IFA refines local age-discriminative representations within each image, while PG-ACIA uses multi-scale edge priors to guide cross-image interaction toward age-sensitive regions such as wrinkles. Finally, an anchored regression network (ARN) predicts age through a soft-weighted combination of multiple linear regressors for robust age estimation under diverse facial aging patterns. Experiments on four benchmark datasets, namely MORPH Album II, MegaAge-Asian, FG-NET and Adience, demonstrate that the proposed method achieves superior performance across multiple evaluation metrics, validating the effectiveness of the CIIT in capturing shared facial characteristics.

Abstract China’s white-collar workers in the digital age face significant occupational health risks, including threats to both physical and mental well-being. Excessive workloads undermine their rights to disconnect and rest, thereby heightening the risks of chronic illness and sudden death. Exposure to negative content and work-related pressure adversely impacts mental health. Often excluded from labor law protections and receiving less attention than common platform workers, many emerging white-collar workers lack traditional safeguards and post-incident support. Urgent regulatory reforms are necessary to mandate that enterprises at the end of the supply chain provide work guidelines and risk training, and establish mental health databases. Legal mechanisms should also encourage excluded workers to obtain independent health insurance. Updating China’s outdated labor legislation is imperative to close protection gaps and address the vulnerabilities affecting this workforce.