Chicago — Bony remodeling appears to play a significant role in facial aging, and facial rejuvenation cosmetic surgery techniques need to address those changes in order to achieve optimal outcomes, says David Kahn, M.D., an assistant professor, division of plastic and reconstructive surgery, Stanford University, Stanford, Calif.
To investigate age-related changes in facial bones, Dr. Kahn and colleagues from the division of plastic and reconstructive surgery at Stanford analyzed measurements taken from three-dimensional reconstructions of computed tomography (CT) data. The study included 10 males and 10 females within each of three age groups: 25 to 44 years old, 45 to 64 years old, and older than 65. Comparisons were made for each gender across the different age categories.
Results of an initial analysis focusing on the central face were presented at the annual meeting of the American Society of Plastic Surgeons. That study measured the glabellar, maxillary and pyriform angles as well as the volume of the pyriform aperture, and its results showed there appeared to be skeletal remodeling with age that the investigators believe represents a loss of bone volume."Our study expands on previous research to reinforce the idea that facial aging involves more than just the skin and soft tissues, but rather is accompanied by bone recession that acts to compound the effects of skin and soft tissue changes in causing facial sagging and wrinkles," Dr. Kahn says. "On that basis, it would appear that aesthetic surgery procedures should aim not just to add volume to the face or solely to tighten the skin, but rather must combine techniques to augment volume and reduce the skin and soft tissue envelope."
The measurements obtained showed changes in both the glabellar and maxillary angles indicative of bone recession with age. The angle at the pyriform aperture was not significantly different across age groups, but the pyriform aperture volume was increased.
"We believe the latter phenomenon may be due to bone recession around the edges, and that this loss of bony support over time may underlie the tendency for the tip of the nose to gradually droop with increasing age," Dr. Kahn tells Cosmetic Surgery Times.
Comparisons between gender groups indicated the facial bony remodeling occurred earlier in females than in males. That finding is consistent with the fact that women seek facial cosmetic enhancement at a younger age than men, he notes.
Dr. Kahn believes the results of his study indicate there should be increasing attention to the use of fillers for soft tissue augmentation. Although there appears to be loss of bony volume, he expressed hesitance about a role of implants, as their cosmetic effects could be altered by bony remodeling that continues over time.
Currently, Dr. Kahn and his colleagues are completing their investigation by assessing changes in bone that occur around the orbit and in the lower face around the jaw. He acknowledges that the ideal study would be a longitudinal assessment characterizing changes that occur over time in the same individual. Nevertheless, he believes his research offers several strengths.
"Earlier research investigating age-related changes in the craniofacial skeleton through adulthood have been limited in number and yielded conflicting results, with some reporting a loss of volume and others concluding the bones expand," Dr. Kahn says. "Compared with some of those previous studies, we believe ours provides more accurate information because it analyzes three-dimensional CT scans rather than two-dimensional, lateral cephalometric X-rays. In addition, our study population includes a larger number of subjects and persons of both genders rather than males only."
Robert Shaw, a medical student at Stanford University who collaborated with Dr. Kahn, presented this research on his behalf in Chicago.