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Quantified Differences in Measuring the Aging Face Using Three-Dimensional Imaging
Vivian M. Hsu, MD, Joshua Cornman-Homonoff, BS, Ari M. Wes, BS, Ivona Percec, MD/PhD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: The aging face has been extensively studied but is still not well understood. Rejuvenation techniques have been developed in response to changes that are clinically observed. An objective method of quantifying age-related changes in the soft tissue of the face may help us further understand not only what areas of the face are the most affected but also the degree of change that occurs over time.
The purpose of this study is to investigate a novel approach to measuring facial aging using three-dimensional imaging technology. We hypothesize that changes in the strain of skin and soft tissue of the face with age are quantifiable and are most pronounced in regions of active facial expression.
METHODS: Thirteen subjects (8 women and 5 men) between the ages of 18-70 were imaged using a dual camera system and three-dimensional optical analysis (ARAMIS, Trilion Quality Systems). Each subject was imaged at rest and with the following facial expressions: 1) smile, 2) laughter, 3) surprise, 4) anger, 5) grimace, and 6) pursed lips. No subjects had a history of facial rejuvenation procedures. The maximum, minimum, and average principle strains were computed from each dominant region of facial movement for each subject and compared.
RESULTS: Dominant areas of facial expression centralized to the perioral region with all tested expressions. In subjects over the age of 40, there was a statistically significant difference in maximum major strain in the perioral region while pursing lips as compared to subjects under the age of 40 (58.4% vs. 33.8%, p = 0.015). The face was also affected as a whole by pursing lips, with a greater degree of compression of the surrounding soft tissue in subjects over the age of 40 as compared to subjects under the age of 40 (5.3% vs. 3.9%, p = 0.004). Specific components of lip pursing were then analyzed, demonstrating a significantly greater degree of strain from the nasolabial fold region in subjects over 40 compared to those under 40 (61.6% vs. 32.9%, p = 0.007). Overall, we observed a greater degree of unpredictability in the older age group when comparing the symmetry of strain in each subject’s expressions. Notably, the asymmetry in strain at the nasolabial fold region was also greater in the older age group (18.4% vs. 5.4%, p = 0.03). The differences in the remaining actions in the 2 groups were not statistically significant.
CONCLUSION: This pilot study demonstrates that the aging face can be critically evaluated in a novel manner using principle strain analysis. Our data illustrate that the perioral region undergoes significant and quantifiable changes with age. Activation of the perioral musculature appears to increase soft tissue strain with age and also affects the surrounding soft tissue. We believe that this dynamic imaging modality has multiple applications for advancing our understanding of aging face anatomy and for planning and evaluating facial rejuvenation and reconstruction.
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