title: Adult facial growth: applications to aesthetic surgery.
abstract: 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.
authors.affiliation: ralevinemd@att.net
authors.forename: Richard A
authors.initials: RA
authors.lastname: Levine
authors.forename: Jaime R
authors.initials: JR
authors.lastname: Garza
authors.forename: Peter T H
authors.initials: PT
authors.lastname: Wang
authors.forename: C Lynn
authors.initials: CL
authors.lastname: Hurst
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Dev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002508:Cephalometry; D004954:Esthetics; D005145:Face / Q000033:anatomy & histology* / Q000601:surgery; D005147:Facial Bones / Q000254:growth & development* / Q000601:surgery; D006801:Humans; D008445:Maxillofacial Development; D008875:Middle Aged; D013997:Time Factors