title: The "Brown sisters": photogrammetric analysis of brow and cheek descent.
abstract: BACKGROUND
  Due to the absence of accurate tools and appropriate photographic material there is a paucity of objective studies on facial aging in the modern literature.
  
  
  OBJECTIVE
  To measure changes in two elements of the face: brow ptosis and cheek mass migration, using an objective tool that we developed which we then used to evaluate facial aging in two subjects studying serial professional photographs over a 25 year period.
  
  
  METHODS
  We studied the photographic atlas of the "Brown Sisters," a record of the yearly group photograph of four sisters taken by the photographer Nicolas Nixon. For technical reasons only two of the sisters fulfilled the criteria we set for the study. We used the interpupillary distance of each photograph studied to standardize the brow height and cheek mass distance from the interpupillary line.
  
  
  RESULTS
  We observed progressive medial brow descent occurring at about the age of 30, with apparent stabilization thereafter. In contrast, there was a continuous process of lateral brow descent through the years. A process of gradual cheek mass descent was noted in the second half of the third decade.
  
  
  CONCLUSIONS
  Our results indicate that the dynamic brow changes start in the second half of the third decade, with more significant lateral brow descent than medial brow descent. The cheek mass reflective point moves in an inferior-lateral direction. The tool we developed can be used to follow aging changes and postoperative results, thereby helping the surgeon achieve true rejuvenation surgery.
authors.affiliation: Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Friedman
authors.forename: Jacob
authors.initials: J
authors.lastname: Golan
authors.forename: Avshalom
authors.initials: A
authors.lastname: Shalom
authors.forename: Melvyn
authors.initials: M
authors.lastname: Westreich
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology*; D000886:Anthropometry / Q000379:methods*; D002610:Cheek / Q000033:anatomy & histology*; D003238:Connective Tissue / Q000033:anatomy & histology; D005260:Female; D005546:Forehead / Q000033:anatomy & histology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008875:Middle Aged; D010780:Photogrammetry / Q000379:methods*; D010826:Physiognomy; D015203:Reproducibility of Results; D055815:Young Adult