Three-Dimensional Computed Tomography–Based Longitudinal Analysis of Facial Skeletal Aging

Abstract Background Facial aging involves complex, region-specific changes in both soft tissue and the underlying bone. Although skeletal remodeling is believed to contribute significantly, most studies rely on cross-sectional imaging, which limits the understanding of longitudinal bony changes in individuals over time. Objectives The authors aimed to quantify and characterize age-related changes in facial skeletal morphology using 3-dimensional (3D) computed tomography (CT) scans of the same individuals obtained approximately a decade apart. To the authors’ knowledge, this is the first study to longitudinally assess skeletal facial aging within the same patients. Methods The authors conducted a retrospective analysis of 96 Caucasian adults (56 males, 40 females; mean baseline age: 34.71 years) who underwent 2 facial CT scans spaced an average of 11.11 years apart. Scans were reconstructed in 3D, and anatomical measurements were performed across upper, middle, and lower facial thirds. Changes were analyzed using paired t tests and analysis of variance (P < .05). Results Significant reductions were observed in vertical facial height (−10.43 mm), transverse width (−5.88 mm), and glabella (−6.47°), pyriform (−5.03°), and maxillary (−11.08°) angles. Orbital aperture area (+91 mm2) and mandibular angle (+29.78°) increased with age. Most changes were most pronounced in participants aged 30 to 50 years. Conclusions The facial skeleton undergoes measurable remodeling with age. These longitudinal findings support the need for facial rejuvenation strategies that address bony as well as soft tissue changes. A deeper understanding of skeletal aging may enable more anatomically accurate and durable aesthetic interventions. Level of Evidence: 3 (Therapeutic)