Skin Flow and Shape in the Aging Face: A Visualization.

BACKGROUND: Although many aspects of the aging face are common knowledge, there are competing opinions about the path of skin across the face with age, here called "flow" or "displacement." OBJECTIVES: The goal of this exploration was to define the actual pattern and vectors of skin displacement with age and to provide visual models for the visual phenomena of facial aging. METHODS: Three-dimensional scans of 280 male participants and 387 female participants in 2 age groups, from 25 to 35 and from 65 and up, were obtained. The digital images were registered and landmarked, and the surface contours were averaged as in previous studies. Novel methods of analysis were applied to create vector maps of skin displacement as well as landmark tracking with age over the entire face. RESULTS: Most of the surface of the model, and by extension the facial skin, flows from superior to inferior relative to the nasion. The entire upper face and cheek down to the level of the nasal base shows minimal displacement, 0 to 2 mm, and then stretches progressively to the jawline. Retrusion of the lips is a major definer of the nasolabial crease/fold complex. Weight has a major effect on the vectors of facial shape. CONCLUSIONS: Cheeks age largely by progressive inferior flow of skin. The nasolabial crease is greatly influenced by retrusion of the lips. Other previously described shape changes are confirmed and visualized. The conclusions presented here are largely supported by the videos, which the reader should review.