title: Perception of Age, Attractiveness, and Tiredness After Isolated and Combined Facial Subunit Aging.
abstract: BACKGROUND
  Patients often seek help to redress aging that affects various regions of the face (subunits). The purpose of this study was to determine how aging of different facial subunits impacts perception of age, attractiveness, and tiredness.
  
  
  METHODS
  Frontal and lateral view facial photographs of a middle-aged woman were modified using imaging software to independently age different facial features. Sixty-six subjects were administered with a questionnaire, and presented with a baseline unmodified picture and others containing different individual or grouped aging of facial subunits. Test subjects were asked to estimate the age of the subject in the image and quantify (0-10 scale) how "tired" and "attractive" they appeared. Facial subunits were organized following rank assignment regarding impact on perception of age, attractiveness, and tiredness.
  
  
  RESULTS
  The correlation coefficient between age and attractiveness had a strong inverse relationship of approximately -0.95 in both lateral and frontal views. From most to least impact in age, the rank assignment for frontal view facial subunits was full facial aging, middle third, lower third, upper third, vertical lip rhytides, horizontal forehead rhytides, jowls, upper eyelid ptosis, loss of malar volume, lower lid fat herniation, deepening glabellar furrows, and deepening nasolabial folds. From most to least impact in age, the rank assignment for lateral view facial subunits was severe neck ptosis, jowls, moderate neck ptosis, vertical lip rhytides, crow's feet, lower lid fat herniation, loss of malar volume, and elongated earlobe.
  
  
  CONCLUSIONS
  This study provides a preliminary template for further research to determine which anatomical subunit will have the most substantial effect on an aged appearance, as well as on the perception of tiredness and attractiveness.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, CT, 06520, USA.
authors.forename: Antonio Jorge
authors.initials: AJ
authors.lastname: Forte
authors.affiliation: Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, CT, 06520, USA.
authors.forename: Tom W
authors.initials: TW
authors.lastname: Andrew
authors.affiliation: Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, CT, 06520, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Colasante
authors.affiliation: Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, CT, 06520, USA. john.persing@yale.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Persing
mesh_terms: D000328:Adult; D000375:Aging / Q000523:psychology; D001290:Attitude; D001504:Beauty; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015595:Skin Aging
keywords: Aging; Beauty; Crow’s feet; Facial plastics; Facial subunit; Perception; Plastic surgery; Rejuvenation