Pooja Mally1, Craig N Czyz2, Allan E Wulc3. 1. Dr Mally is a clinical instructor, Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania. 2. Dr Czyz is an assistant professor, Division of Ophthalmology, Oculofacial Plastic and Reconstructive Surgery Section, Ohio University/OhioHealth Doctor's Hospital, Columbus. 3. Dr Wulc is a clinical instructor, Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania; an associate professor, Department of Ophthalmology and Otolaryngology, Abington Memorial Hospital, Abington, Pennsylvania; and an associate professor, Scheie Eye Institute, University of Pennsylvania, Philadelphia awulcmd@gmail.com.
Abstract
BACKGROUND: With respect to the pathogenesis of periorbital and midfacial aging, gravity may play a greater role than volume loss. OBJECTIVES: The authors determined the effect of shifting from the upright to the supine position on specific attributes of facial appearance and ascertained whether facial appearance in the supine position bore any resemblance to its appearance in youth. METHODS: Participants who showed signs of midface aging were positioned in the upright and supine positions, and photographs were obtained during smiling and repose. For each photograph, examiners graded the following anatomic parameters, using a standardized scale: brow position, tear trough length and depth, steatoblepharon, cheek volume, malar bags/festoons, and nasolabial folds. Some participants provided photographs of themselves taken 10 to 15 years earlier; these were compared with the study images. RESULTS: Interobserver correlation was strong. When participants were transferred from upright to supine, all anatomic parameters examined became more youthful in appearance; findings were statistically significant. The grading of anatomic parameters of the earlier photographs most closely matched that of current supine photographs of the subjects smiling. CONCLUSIONS: In the supine position, as opposed to the upright position, participants with signs of midface aging appear to have much more volume in the periorbita and midface. For the subset of participants who provided photographs obtained 10 to 15 years earlier, the appearance of facial volume was similar between those images and the current supine photographs. This suggests that volume displacement due to gravitational forces plays an integral role in the morphogenesis of midface aging.
BACKGROUND: With respect to the pathogenesis of periorbital and midfacial aging, gravity may play a greater role than volume loss. OBJECTIVES: The authors determined the effect of shifting from the upright to the supine position on specific attributes of facial appearance and ascertained whether facial appearance in the supine position bore any resemblance to its appearance in youth. METHODS:Participants who showed signs of midface aging were positioned in the upright and supine positions, and photographs were obtained during smiling and repose. For each photograph, examiners graded the following anatomic parameters, using a standardized scale: brow position, tear trough length and depth, steatoblepharon, cheek volume, malar bags/festoons, and nasolabial folds. Some participants provided photographs of themselves taken 10 to 15 years earlier; these were compared with the study images. RESULTS: Interobserver correlation was strong. When participants were transferred from upright to supine, all anatomic parameters examined became more youthful in appearance; findings were statistically significant. The grading of anatomic parameters of the earlier photographs most closely matched that of current supine photographs of the subjects smiling. CONCLUSIONS: In the supine position, as opposed to the upright position, participants with signs of midface aging appear to have much more volume in the periorbita and midface. For the subset of participants who provided photographs obtained 10 to 15 years earlier, the appearance of facial volume was similar between those images and the current supine photographs. This suggests that volume displacement due to gravitational forces plays an integral role in the morphogenesis of midface aging.
Authors: Hugo Santos Cunha; Cícero André da Costa Moraes; Rodrigo de Faria Valle Dornelles; Everton Luis Santos da Rosa Journal: Oral Maxillofac Surg Date: 2020-11-08
Authors: Lisa Donofrio; Jean Carruthers; Bhushan Hardas; Diane K Murphy; Derek Jones; Jonathan M Sykes; Alastair Carruthers; Lela Creutz; Ann Marx; Sara Dill Journal: Dermatol Surg Date: 2016-10 Impact factor: 3.398