Changes in ocular globe-to-orbital rim position with age: Implications for aesthetic blepharoplasty of the lower eyelids (original) (raw)
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Age-Related Changes of the Orbit and Midcheek and the Implications for Facial Rejuvenation
Aesthetic Plastic Surgery, 2007
Background:Aging of the midface is complex and poorly understood. Changes occur not only in the facial soft tissues, but also in the underlying bony structure. Computed tomography (CT) imaging was used for investigating characteristics of the bony orbit and the anterior wall of the maxilla in patients of different ages and genders. Methods: Facial CT scans were performed for 62 patients ranging in age from 21 to 70 years, who were divided into three age groups: 21À30 years, 41À50 years, and 61À70 years. Patients also were grouped by gender. The lengths of the orbital roof and floor and the angle of the anterior wall of the maxilla were recorded on parasagittal images through the midline of the orbit for each patient. Results: The lengths of the orbital roof and floor at their midpoints showed no significant differences between the age groups. When grouped by gender, the lengths were found to be statistically longer for males than for females. The angle between the anterior maxillary wall and the orbital floor was found to have a statistically significant decrease with advancing age among both sexes. Conclusion: Bony changes occur in the skeleton of the midcheek with advancing age for both males and females. The anterior maxillary wall retrudes in relation to the bony orbit, which maintains a fixed anteroposterior dimension at its midpoint. These changes should be considered in addressing the aging midface.
Aesthetic Plastic Surgery, 2012
In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping have constituted the cornerstone of most facial rejuvenation procedures. Changes in the facial skeleton that occur with aging and their impact on facial appearance have not been well appreciated. Accordingly, failure to address changes in the skeletal foundation of the face may limit the potential benefit of any rejuvenation procedure. Correction of the skeletal framework is increasingly viewed as the new frontier in facial rejuvenation. It currently is clear that certain areas of the facial skeleton undergo resorption with aging. Areas with a strong predisposition to resorption include the midface skeleton, particularly the maxilla including the pyriform region of the nose, the superomedial and inferolateral aspects of the orbital rim, and the prejowl area of the mandible. These areas resorb in a specific and predictable manner with aging. The resultant deficiencies of the skeletal foundation contribute to the stigmata of the aging face. In patients with a congenitally weak skeletal structure, the skeleton may be the primary cause for the manifestations of premature aging. These areas should be specifically examined in patients undergoing facial rejuvenation and addressed to obtain superior aesthetic results.
2013
The traditional approach to assessing the face is to consider the face in thirds (upper, middle, and lower thirds). While useful, this approach limits conceptualization, as it is not based on the function of the face. From a functional perspec tive, the face has an anterior aspect and a lateral aspect. The anterior face is highly evolved beyond the basic survival needs, specifically, for communication and facial expression. In contrast, the lateral face predominantly covers the struc tures of mastication. A vertical line descending from the lateral orbital rim is the approximate division between the anterior and lateral zones of the face. Internally, a series of facial retaining ligaments are strategically located along this line to demarcate the anterior from the lateral face (Fig. 6.1). The mimetic muscles of the face are located in the superficial fascia of the anterior face, mostly around the eyes and the mouth. This highly mobile area of the face is designed to allow fine mov...
Adult Facial Growth: Applications to Aesthetic Surgery
Aesthetic Plastic Surgery, 2003
Background: Reshaping of the face with age is a result of volume change and loss of support. It is not well understood which tissues are involved in this process. Recent publications suggest that adult bone growth may have a significant role. Objective: We report a longitudinal cephalometric analysis of midfacial growth in adults to determine the role of bone in facial aging. Methods: The Behrents modification of the Bolton Cephalometric study in patients up to age 83 was reviewed. A trigonometric analysis targeted orbital and anterior maxillary growth. Results: Facial bone growth is shown to continue throughout adulthood. Anterior descent creates increased bone projection. Conclusions: The appearance of facial aging is caused by attrition of soft tissue volume and loss of support. The deficiency of maxillary bone projection seen in some patients, with tear trough depression and negative vector eyelid (polar bear), preexists adulthood and is unmasked with age.
Changes in facial shape with age: an analysis with three-dimensional imaging
European Journal of Plastic Surgery, 2011
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.
Aging in the Craniofacial Complex
The Angle Orthodontist, 2008
Objective: To describe the dental arch changes occurring after adolescence through the sixth decade of life. Materials and Methods: Longitudinal dental casts from 40 patients (20 male and 20 female) were digitized and analyzed. Measurements were recorded after the presumed cessation of circumpubertal growth (T1), at approximately 47 years of age (T2), and at least one decade later (T3) were compared. Results: The majority of the measurements were found to have a significant time effect, demonstrating at least some level of change throughout the aging process (T1–T3). Exceptions to this observation were the posterior maxillary arch width measurements, mandibular intermolar and interpremolar (as measured at the second premolars) widths, the maxillary incisor irregularity index, overjet, overbite, and curve of Spee. The T1–T3 changes reflected for the most part the T1– T2 changes, while the T2–T3 changes affected overall modifications only for the mandibular intercanine width and maxil...
CHAPTER 1 Anatomy and the Aging Changes of the Face and Neck
2009
With aging, all facial elements undergo specific modifications. This results in an appearance typical for a specific age group, well recognizable by others. These signs of aging, most of which are demonstrated by Figure 1.1, which shows, split-face, the same man at ages twenty-three and fifty-one, include the following:
Age- and sex-related changes in the soft tissues of the orbital region
Forensic Science International, 2009
The orbital region plays a predominant role in the evaluation of the craniofacial complex. In the current study information about normal sex-related dimensions of the orbital region, and growth, development and aging, were provided. The three-dimensional coordinates of several soft-tissue landmarks on the orbits and face were obtained by a non-invasive, computerized electromagnetic digitizer in 531 male and 357 female healthy subjects aged 4-73 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, soft-tissue orbital area, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Biocular and intercanthal widths, length of the eye fissure, soft-tissue orbital area, and the inclination of the orbit relative to the true horizontal, were significantly larger in men than in women (p < 0.01), with a significant effect of age (p < 0.001), and significant age  sex interactions (p < 0.001). Orbital height, and the height-to-width ratio increased as a function of age (p < 0.001), but without gender-related differences. The inclination of the orbit relative to Frankfurt plane, and the inclination of the eye fissure did not differ between men and women, but modified as a function of age (p < 0.001), with different sex-related patterns (sex  age interaction, p < 0.001). On average, the paired measurements were symmetric, with similar values within each sex and age group. Overall, when compared to literature data, some differences were found due to both ethnicity, and different instruments. Nevertheless, during childhood, adolescence, and young adulthood, the age-related trends for linear dimensions were similar to those found in previous studies, while no previous data exist for older adults. During aging an increment in soft-tissue orbital area was found, with a progressive downward shift of landmark orbitale. Data collected in the present investigation could serve as a data base for the quantitative description of human orbital morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age-and sex-based data banks. ß
Regional shape change in adult facial bone curvature with age
American Journal of Physical Anthropology, 2010
Life expectancies have increased dramatically over the last 100 years, affording greater opportunities to study the impact of age on adult craniofacial morphology. This article employs a novel application of established geometric morphometric methods to examine shape differences in adult regional facial bone curvature with age. Three-dimensional semilandmarks representing the curvature of the orbits, zygomatic arches, nasal aperture, and maxillary alveolar process were collected from a cross-sectional cranial sample of mixed sex and ancestry (male and female; African-and European-American), partitioned into three age groups (young adult 5 18-39; middle-aged 5 40-59 years; and elderly 5 601 years). Each facial region's semilandmarks were aligned into a common coordinate system via generalized Procrustes superim-position. Regional variation in shape was then explored via a battery of multivariate statistical techniques. Agerelated shape differences were detected in the orbits, zygomatic arches, and maxillary alveolar process. Interactions between age, sex, and ancestry were also identified. Vector plots revealed patterns of superoinferior compression, lateral expansion, and posterior recession depending on the population/subpopulation, location, and age groups examined. These findings indicate that adult craniofacial curvature shape is not static throughout human life. Instead, age-related spatial modifications occur in various regions of the craniofacial skeleton. Moreover, these regional alterations vary not only through time, but across human populations and the sexes.