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Observations on Periorbital and Midface Aging

Lambros, Val M.D.

Plastic and Reconstructive Surgery: October 2007 - Volume 120 - Issue 5 - p 1367-1376
doi: 10.1097/01.prs.0000279348.09156.c3

Background: Many of the anatomical changes of facial aging are still poorly understood. This study looked at the aging process in individuals linearly over time, focusing on aspects of periorbital aging and the upper midface.

Methods: The author compared photographs of patients’ friends and relatives taken 10 to 50 years before with closely matched recent follow-up pictures. The best-matching old and recent pictures were equally sized and superimposed in the computer. The images were then assembled into GIF animations, which automate the fading of one image into the other and back again indefinitely.

Results: The following findings were new to the author: (1) the border of the pigmented lid skin and thicker cheek skin (the lid-cheek junction) is remarkably stable in position over time, becoming more visible by contrast, not by vertical descent as is commonly assumed. (2) Orbicularis wrinkles on the cheek and moles and other markers on the upper midface were also stable over decades. (3) With aging, there can be a distinct change in the shape of the upper eyelid. The young upper lid frequently has a medially biased peak. The upper lid peak becomes more central in the older lid. This article addresses these three issues. No evidence was seen here for descent of the globe in the orbit.

Conclusions: There seems to be very little ptosis (inferior descent) of the lid-cheek junction or of the upper midface. These findings suggest that vertical descent of skin, and by association, subcutaneous tissue, is not necessarily a major component of aging in those areas. In addition, the arc of the upper lid changes shape in a characteristic way in some patients. Other known changes of the periorbital area are visualized.

Supplemental Digital Content is available in the text.

Newport Beach, Calif.

From the Department of Plastic Surgery, University of California, Irvine.

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Received for publication October 24, 2006; accepted December 12, 2006.

Presented at the 2002 Annual Meeting of the Society for Aesthetic Plastic Surgery, in Las Vegas, Nevada, April 27 through May 3, 2002; 2003 Annual Meeting of the Society for Aesthetic Plastic Surgery, in Boston, Massachusetts, May 16 through 21, 2003; 2004 Annual Meeting of the Society for Aesthetic Plastic Surgery, in Vancouver, British Columbia, Canada, April 15 through 21, 2004; 70th Annual Scientific Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, November 3 through 7, 2001; and 74th Annual Meeting of the American Society of Plastic Surgeons, in Chicago, Illinois, September 24 through 28, 2005.

Val Lambros, M.D., Department of Plastic Surgery, University California, Irvine, 360 San Miguel, Suite 406, Newport Beach, Calif. 92660,

©2007American Society of Plastic Surgeons