title: Aging of the facial skeleton: aesthetic implications and rejuvenation strategies.
abstract: BACKGROUND
  Facial aging is a dynamic process involving the aging of soft-tissue and bony structures. In this study, the authors demonstrate how the facial skeleton changes with age in both male and female subjects and what impact these structural changes may have on overall facial aesthetics.
  
  
  METHODS
  Facial bone computed tomographic scans were obtained from 60 female and 60 male Caucasian subjects. Twenty male and 20 female subjects were placed in three age categories (20 to 40 years, 41 to 64 years, and 65 years and older). Each computed tomographic scan underwent three-dimensional reconstruction with volume rendering. Edentulous patients were excluded. The following measurements were obtained: upper face (orbital aperture area, orbital aperture width, and curvilinear analysis of the superior and inferior orbital rims), midface (glabellar angle, pyriform angle, maxillary angle, and pyriform aperture area), and lower face (bigonial width, ramus breadth, ramus height, mandibular body height, mandibular body length, and mandibular angle).
  
  
  RESULTS
  The orbital aperture width and orbital aperture area increased significantly with age for both sexes. There was a significant increase in orbital aperture size (increase in height of the superomedial and inferolateral orbital rim) in both sexes. The glabellar and maxillary angles decreased significantly with age for both sexes, whereas the pyriform aperture area significantly increased for both sexes with age. Mandibular length and height both decreased significantly for each sex. The mandibular angle significantly increased with age for both sexes.
  
  
  CONCLUSIONS
  These results suggest that the skeletal morphology of the face changes with age. This change in skeletal morphology may contribute to the appearance of the aging face.
authors.affiliation: Rochester, N.Y.; Stanford, Calif.; and Cambridge, Mass. From the Divisions of Plastic and Reconstructive Surgery, Departments of General Surgery of University of Rochester Medical Center, Stanford University Medical Center, and Harvard University Medical Center.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Shaw
authors.forename: Evan B
authors.initials: EB
authors.lastname: Katzel
authors.forename: Peter F
authors.initials: PF
authors.lastname: Koltz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Yaremchuk
authors.forename: John A
authors.initials: JA
authors.lastname: Girotto
authors.forename: David M
authors.initials: DM
authors.lastname: Kahn
authors.forename: Howard N
authors.initials: HN
authors.lastname: Langstein
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D004954:Esthetics; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012060:Rejuvenation / Q000502:physiology; D014057:Tomography, X-Ray Computed