Changes in facial shape with age: an analysis with three-dimensional imaging

The appearance of the aged face has traditionally been attributed to soft tissue changes with surgical treatments targeting ptosis of skin, SMAS, and fat. However, true facial aging is recognized as a combination of soft tissue and skeletal changes, which continue to be integrated into a model for facial aging. With a greater understanding of these changes, techniques in facial rejuvenation will continue to evolve. Three-dimensional imaging technology was used in this study. Measurements correlating with mid- and lower-face changes were compared for each three-dimensional facial image of 31 mother–daughter matched controls. Each mother image was superimposed on the corresponding daughter, using registration of the upper face to visualize mid-face differences between pairs. Also, measurements of women in four age groups were compared using a one-way ANOVA. The ratios of Po-A:Po-N were significantly greater in daughters in comparison to their mothers (p = 0.0073), with the majority of mother subjects showing a more acute Po-N-A angle (p < 0.042). An investigation between age groups exhibited significant difference between the youngest (18–29) and oldest (60+) groups for Po-A:Po-N length ratio, Po-B:Po-N length ratio, Po-N-A angle, and Po-N-B angle. Differences between the 30–44 and 60+ age groups were also significant for the Po-A:Po-N and Po-B:Po-N length ratios. The results from this study suggest a posterior movement of the mid and lower face with age. This multi-factorial process makes facial rejuvenation more complex than initially perceived, and recognizing it will facilitate better rejuvenation strategies in the future.