Think you know your way around the hills and valleys of an aging face? Think again, urges one plastic surgeon who is using 3-D photos of faces to challenge assumptions about how our appearances change over time.
The nose gets larger and its tip plunges over time, right? Wrong. Lower eyelids sag as we get older? Nope. The nasolabial fold grows because our cheeks slide down? Not really.
"If we’re going to be the people who understand the face the best, we need to understand how the face ages. But we don’t," says Val Lambros, M.D., FACS, a Newport Beach, Calif., plastic surgeon. "The goal here is simple: To show true, valid pictures of facial aging."
Dr. Lambros spoke about his facial research earlier this year at Plastic Surgery The Meeting 2016 in Los Angeles and in a conversation with Cosmetic Surgery Times.
In 2005, Dr. Lambros began using a 3-D camera to take photos of about 1,400 plastic surgeons and about 450 others. The photos can be averaged to reveal how typical people age over time.
"One then can see, for example, the average face of all the women from 20 to 30 and all the women from 68 and up," he says. "I then made an animation of the two so you can see the average aging pattern of young to old faces," he says. "It is not an artist's conception. It is the true real way that faces age."
Here are some of the findings reported by Dr. Lambros:
The nose recedes.
"I had seen evidence that the nose recedes in earlier studies of mine, but this research shows that the effect is universal enough to be in the averages," he says.
The tip of the nose doesn't plunge with aging.
This is an illusion created by the shortening of the lip and changes in the posterior nose, he says.
The lower eyelids don't fall.
The eyes appear smaller as we get older, he says. But don't blame the lower eyelids. "All of us think lower lids fall down because those are the kinds of patients we see. In fact, the average lower lid rises."
Instead, he says, it's the upper lid aperture that gets smaller, helping to explain some of the smaller appearance of the eyes.
There's more to the nasolabial fold than just the cheek.
Procedures to improve the nasolabial fold are among the hallmarks of cosmetic surgery. But why does the fold become more prominent — and endlessly aggravating for many people — as we age?
"Everyone has thought that the nasolabial fold comes from the cheek sliding down. That's because pulling on the cheek makes the fold look better," Dr. Lambros says. "What this research shows is that the nasolabial crease gets partially formed by the lip thinning as well."
Men age similarly... and differently.
Men's faces behave in similar ways to women's faces during aging, but there's an important exception: Older men's heads are about 5 mm bigger than when they are younger.”
Changes in bone aren't that significant.
Changes in bone aren't as important as you may assume. "Soft tissue alone can explain lip and nasal base changes, not bone," he says. “Soft tissue changes are big, and hard tissue changes are small. That occurs all over the face, although hard tissue does make a difference in the posterior mandible."
Why does all this matter? "When you can see the change of the tissues and have a picture of that in your mind from studies like this," Dr. Lambros says, "you have a complete view of how the face has changed, and you make different decisions."
Disclosures: Dr. Lambros reports no relevant disclosures.