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The Relationship between Age and Facial Asymmetry

Linden, Olivia E. M.D.; He, Jun Kit B.A.; Morrison, Clinton S. M.D.; Sullivan, Stephen R. M.D., M.P.H.; Taylor, Helena O. B. M.D., Ph.D.

Plastic and Reconstructive Surgery: November 2018 - Volume 142 - Issue 5 - p 1145-1152
doi: 10.1097/PRS.0000000000004831
Cosmetic: Original Articles
Press Release

Background: Facial symmetry is a fundamental goal of plastic surgery, yet some asymmetry is inherent in any face. Three-dimensional photogrammetry allows for rapid, reproducible, and quantitative facial measurements. With this tool, the authors investigated the relationship between age and facial symmetry.

Methods: The authors imaged normal subjects using three-dimensional photogrammetry. Facial symmetry was calculated by identifying the plane of maximum symmetry and the root-mean-square deviation. Regression analysis was used to assess the relationship between age and symmetry. Subgroup analyses were performed among facial thirds.

Results: The authors imaged 191 volunteers with an average age of 26.7 ± 22.2 years (range, 0.3 to 88 years). Root-mean-square deviation of facial symmetry clustered between 0.4 and 1.3 mm (mean, 0.8 ± 0.2 mm). The authors found a significant positive correlation between increasing age and asymmetry (p < 0.001; r = 0.66). The upper, middle, and lower facial third’s average root-mean-square deviations were 0.5 ± 0.2 mm (range, 0.2 to 1.2 mm), 0.6 ± 0.2 mm (range, 0.2 to 1.4 mm), and 0.6 ± 0.2 mm (range, 0.2 to 1.2 mm), respectively. Asymmetry also increased with age across all facial thirds (p < 0.001).

Conclusions: Facial asymmetry increases with age in each facial third, with a greater asymmetry and increase in asymmetry in the lower two-thirds. Contributing factors may include asymmetric skeletal remodeling along with differential deflation and descent of the soft tissues. The observed correlation between increasing facial asymmetry and age may be a useful guide in plastic surgery to produce age-matched features.

San Francisco, Calif.; Providence, R.I.; Rochester, N.Y.; and Cambridge, Mass.

From the Department of Radiology and Biomedical Imaging, University of California–San Francisco; the Warren Alpert Medical School of Brown University; the Division of Plastic Surgery, University of Rochester; and the Division of Plastic Surgery, Mount Auburn Hospital and Harvard Medical School.

Received for publication October 6, 2017; accepted April 17, 2018.

Presented at 57th Annual Meeting of the New England Society of Plastic and Reconstructive Surgeons, Inc., in Bretton Woods, New Hampshire, June 10 through 12, 2016.

Disclosure:Dr. Taylor is a consultant for Vision Systems, Inc. The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. The device used in this article is the Canfield Vectra imaging system (Canfield Imaging Systems, Fairfield, N.J.).

Helena O. B. Taylor, M.D., Ph.D., Division of Plastic Surgery, Mount Auburn Hospital, Harvard Medical School, 300 Mount Auburn Street, Suite 304, Cambridge, Mass. 02138,

Copyright © 2018 by the American Society of Plastic Surgeons