This was out of the Feb 2021 Aesthetic Surgery Journal. It was a study to look at facial aging and determine what is the bigger issue.
Is it volume loss?
Or is it volume descent (ie when gravity has pulled your tissue down)?
The study, “Gravity in Midfacial Aging: A 3 Dimensional Study,” was a prospective study to try to quantify in 3 dimensions the effects of gravity on the midface in an upright and supine position. They looked at older and younger patients.
Study:
- 53 female patients
- The younger patients were less than age 40 (n = 9, average 21 years) and age over 40 (n = 44, average 58 years)
- No treatments with dermal fillers or prior cosmetic surgery
- 3D using Vectra HI camera used, in a sitting and supine position
- Volume shifts and displacement of structures in 3D were measured and analyzed.
Findings? When you go from sitting to lying down,
- The tail of the brow elevates
- The tear trough fills (*average volume .22 cc)
- The cheek fat pads shift up and back (*average volume increase 1.2cc)
- The earlobe decreases in height
- And the nasolabial and marionette lines lessen
- The jowls diminished
What does this mean?
First, it means lying down makes everyone look better. Your eyebrows don’t droop, your hollows under your eyes fill, your cheeks are higher.
Second, during their analysis, they found in this cohort the tissue descent was the primary issue, NOT volume loss. They found that typical filler injection amounts equaled the volume loss they saw in those areas.
My thoughts?
I am a huge fan of adding volume (go fat grafting!), but I also agree that volume isn’t always the answer. This study is interesting in trying to add data to truly analyze the face. (I also have a 3D camera, but it is not portable, and I have not been able to figure out how to analyze volume changes accurately.)
I love that it was a prospective study, looking at different aged women, and tried to quantitate the volume change.
I have a few questions about the study. For me, I see a big change in women around the time of menopause, where I feel aging is almost like walking off a cliff. So grouping a 40 year old woman with an 80 year old woman in a small sample size study is distorting. Women do not all go through menopause at the same time, and this is one of the biggest changes to skin elasticity.
Important questions for me for facial aging are
- what is your BMI and
- have you gone through menopause?
Those are two important contributors to facial volume and skin laxity.
In a commentary of this study, they brought up additional points:
- lying down does not equal the changes due to gravity, it changes the vector of pull
- It is unclear how accurate Vectra imaging is for volume measurements
- The commentator feels (as I do) that aging is a combination of deflation and descent
Their conclusions?
- They wonder if smaller, minimally invasive surgery would be beneficial for younger patients.
- Facial volumization should be a more limited adjunct, rather than a primary tool
- 3D analysis can be used to quantify injection amounts
- They think volume loss may be more significant in older women (> age 58)