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Quantitative Mobility Analysis of the Face and its Relevance for Surgical and Non-surgical Aesthetic Facial Procedures

  • Original Article
  • Facial Surgery
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Abstract

Background

Understanding the degree of facial mobility upon postural changes is of great clinical relevance especially if facial assessment, facial measurements and/or facial markings are done in an upright position, but facial procedures are performed in a supine position.

Objective

The objective of this study is to investigate regional facial skin displacement and facial volume changes in individuals between upright and supine positions.

Methods

This multi-center study analyzed a total of 175 study participants with a mean age of 35.0 (10.2) years and a mean body mass index of 24.71 (3.5) kg/m2. 3D surface scanning technology with automated registration and alignment was utilized, and multivariate analyses were performed with adjustment for age, gender, body mass index, facial skin sagging and laxity.

Results

The medial face displaced less than the lateral face in both cranial (0.88 mm) and in lateral (0.76 mm) directions, and the lower face displaced more than the middle face in both cranial (1.17 mm) and lateral directions (1.37 mm). Additionally, the medial face lost, on average, 3.00cc whereas the lateral face increased by 5.86cc in volume; the middle face increased by 2.95cc, whereas the lower face decreased by 0.98cc in volume. All p < 0.001.

Conclusion

Practitioners should be mindful that there is a statistically significant change in facial soft tissues between the upright and supine positions and that the magnitude of the change does not necessarily reflect on the aging process alone but is a multi-factorial process which should be individualized for each patient’s needs.

Level of Evidence IV

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References

  1. Cotofana S, Fratila A, Schenck TL, Redka-Swoboda W, Zilinsky I, Pavicic T (2016) The anatomy of the aging face: a review. Facial Plast Surg 32(3):253–260. https://doi.org/10.1055/s-0036-1582234

    Article  CAS  PubMed  Google Scholar 

  2. Kligman LH (1989) Photoaging. Manifestations, prevention, and treatment. Clin Geriatr Med. https://doi.org/10.1016/s0749-0690(18)30708-0

    Article  PubMed  Google Scholar 

  3. Kligman AM (1969) Early destructive effect of sunlight on human skin. JAMA J Am Med Assoc. https://doi.org/10.1001/jama.1969.03160390039008

    Article  Google Scholar 

  4. Mancini M, Lena AM, Saintigny G et al (2014) MicroRNAs in human skin ageing. Ageing Res Rev 17:9

    Article  CAS  Google Scholar 

  5. Zhang S, Duan E (2018) Fighting against skin aging: the way from bench to bedside. Cell Transplant. https://doi.org/10.1177/0963689717725755

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schenck TL, Koban KC, Schlattau A et al (2018) The functional anatomy of the superficial fat compartments of the face: a detailed imaging study. Plast Reconstr Surg 141(6):1351–1359. https://doi.org/10.1097/PRS.0000000000004364

    Article  CAS  PubMed  Google Scholar 

  7. Cotofana S, Gotkin RH, Frank K et al (2019) The functional anatomy of the deep facial fat compartments. Plast Reconstr Surg 143(1):53–63. https://doi.org/10.1097/PRS.0000000000005080

    Article  CAS  PubMed  Google Scholar 

  8. Sipilä S, Törmäkangas T, Sillanpää E et al (2020) Muscle and bone mass in middle-aged women: role of menopausal status and physical activity. J Cachexia Sarcopenia Muscle. https://doi.org/10.1002/jcsm.12547

    Article  PubMed  PubMed Central  Google Scholar 

  9. Marzetti E, Calvani R, Tosato M et al (2017) Sarcopenia: an overview. Aging Clin Exp Res 29(1):11–17. https://doi.org/10.1007/s40520-016-0704-5

    Article  PubMed  Google Scholar 

  10. Brandt MG, Hassa A, Roth K, Wehrli B, Moore CC (2012) Biomechanical properties of the facial retaining ligaments. Arch Facial Plast Surg 14(4):289–294. https://doi.org/10.1001/archfacial.2011.1533

    Article  PubMed  Google Scholar 

  11. Cotofana S, Gotkin RH, Ascher B et al (2018) Calvarial volume loss and facial aging: a computed tomographic (CT)-based study. Aesthetic Surg J 38(10):1043–1051. https://doi.org/10.1093/asj/sjy096

    Article  Google Scholar 

  12. Frank K, Gotkin RH, Pavicic T et al (2018) Age and gender differences of the frontal bone: a computed tomographic (CT)-based study. Aesthetic Surg J. https://doi.org/10.1093/asj/sjy270

    Article  Google Scholar 

  13. Cotofana S, Gotkin RH, Morozov SP et al (2018) The relationship between bone remodeling and the clockwise rotation of the facial skelton—a computed tomography imaging based evaluation. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000004976

    Article  PubMed  Google Scholar 

  14. Bulut O, Jessica Liu CY, Koca F, Wilkinson C (2017) Comparison of three-dimensional facial morphology between upright and supine positions employing three-dimensional scanner from live subjects. Leg Med 27(February):32–37. https://doi.org/10.1016/j.legalmed.2017.06.002

    Article  Google Scholar 

  15. Hoogeveen RC, Sanderink GCH, Berkhout WER (2013) Effect of head position on cephalometric evaluation of the soft-tissue facial profile. Dentomaxillofac Radiol. https://doi.org/10.1259/dmfr.20120423

    Article  PubMed  PubMed Central  Google Scholar 

  16. Iblher N, Gladilin E, Stark BG (2013) Soft-tissue mobility of the lower face depending on positional changes and age: a three-dimensional morphometric surface analysis. Plast Reconstr Surg 131(2):372–381. https://doi.org/10.1097/PRS.0b013e318278d67c

    Article  CAS  PubMed  Google Scholar 

  17. Mally P, Czyz CN, Wulc AE (2014) The role of gravity in periorbital and midfacial aging. Aesthetic Surg J 34(6):809–822. https://doi.org/10.1177/1090820X14535077

    Article  Google Scholar 

  18. Marin F, Ben Mansour K, Demeter F, Frey P (2015) Displacement of facial soft tissues in upright versus supine positions. Comput Methods Biomech Biomed Engin 18(October):1988–1989. https://doi.org/10.1080/10255842.2015.1069590

    Article  CAS  PubMed  Google Scholar 

  19. Munn L, Stephan CN (2018) Changes in face topography from supine-to-upright position—and soft tissue correction values for craniofacial identification. Forensic Sci Int 289:40–50. https://doi.org/10.1016/j.forsciint.2018.05.016

    Article  PubMed  Google Scholar 

  20. Ozsoy U, Sekerci R, Ogut E (2015) Effect of sitting, standing, and supine body positions on facial soft tissue: detailed 3D analysis. Int J Oral Maxillofac Surg 44(10):1309–1316. https://doi.org/10.1016/j.ijom.2015.06.005

    Article  CAS  PubMed  Google Scholar 

  21. Alexiades-Armenakas M, Rosenberg D, Renton B, Dover J, Arndt K (2010) Blinded, randomized, quantitative grading comparison of minimally invasive, fractional radiofrequency and surgical face-lift to treat skin laxity. Arch Dermatol 146(4):396–405. https://doi.org/10.1001/archdermatol.2010.24

    Article  PubMed  Google Scholar 

  22. Narins RS, Carruthers J, Flynn TC et al (2012) Validated assessment scales for the lower face. Dermatol Surg 38(2 PART 2):333–342. https://doi.org/10.1111/j.1524-4725.2011.02247.x

    Article  CAS  PubMed  Google Scholar 

  23. Cotofana S, Freytag DL, Frank K et al (2020) the bi-directional movement of the frontalis muscle - introducing the line of convergence and its potential clinical relevance. Plast Reconstr Surg 145(5):1155–1162. https://doi.org/10.1097/PRS.0000000000006756

    Article  CAS  PubMed  Google Scholar 

  24. Frank K, Freytag DL, Schenck TL et al (2019) Relationship between forehead motion and the shape of forehead lines—a 3D skin displacement vector analysis. J Cosmet Dermatol. https://doi.org/10.1111/jocd.13065

    Article  PubMed  Google Scholar 

  25. Liew S, Frank K, Kolenda J, Braun M, Cotofana S (2020) A comparison of single versus dual—vector technique using facial suspension threads—a split-face cadaveric study. Dermatol Surg 46:1721

    Article  CAS  Google Scholar 

  26. Braun M, Frank K, Freytag DL et al (2020) The influence of the insertion angle on middle and lower face tissue-mechanics when treating the nasolabial folds with facial suspension threads—an experimental split-face cadaveric study. Facial Plast Surg 23:1–8

    Google Scholar 

  27. Cotofana S, Gotkin RH, Frank K, Lachman N, Schenck TL (2019) Anatomy behind the facial overfilled syndrome: the transverse facial septum. Dermatol Surg. https://doi.org/10.1097/DSS.0000000000002236

    Article  PubMed  Google Scholar 

  28. Casabona G, Bernardini FP, Skippen B et al (2020) How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections. J Cosmet Dermatol 19(2):303–311. https://doi.org/10.1111/jocd.13245

    Article  PubMed  Google Scholar 

  29. Casabona G, Frank K, Koban KC et al (2019) Lifting vs volumizing-The difference in facial minimally invasive procedures when respecting the line of ligaments. J Cosmet Dermatol. https://doi.org/10.1111/jocd.13089

    Article  PubMed  Google Scholar 

  30. Cotofana S, Lachman N (2019) Anatomy of the facial fat compartments and their relevance in aesthetic surgery. JDDG J der Dtsch Dermatol Ges 17(4):399–413. https://doi.org/10.1111/ddg.13737

    Article  Google Scholar 

  31. Stuzin JM, Baker TJ, Gordon HL (1992) The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 89(3):441–449 (discussion 450-1)

    Article  CAS  Google Scholar 

  32. Muzaffar AR, Mendelson BC, Adams WP (2002) Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast Reconstr Surg 110(3):873–884 (discussion 897-911)

    Article  Google Scholar 

  33. Ramesh S, Johnson P, Sarcu D, Wulc AE (2021) Gravity in midfacial aging: a 3-dimensional study. Aesthetic Surg J 41(2):143–151. https://doi.org/10.1093/asj/sjaa021

    Article  Google Scholar 

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Funding

The authors received no financial support for the research, authorship, and publication of this article.

Author information

Author notes

  1. Claudia A. Hernandez and Michael Alfertshofer have contributed equally to this manuscript.

Authors and Affiliations

  1. CH Dermatologia, Medellin, Colombia

    Claudia A. Hernandez

  2. Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Munich, Germany

    Michael Alfertshofer, Konstantin Frank & Lysander Freytag

  3. Private Practice, Cluj-Napoca, Romania

    Diana L. Gavril

  4. Department of Radiology & Medical School, University of Belgrade, Belgrade, Serbia

    Kristina Davidovic

  5. Private Practice, New York, NY, USA

    Robert H. Gotkin

  6. Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA

    Arnaldo Mercado-Perez & Sebastian Cotofana

  7. Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA

    Samir Mardini

Authors
  1. Claudia A. Hernandez
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  2. Michael Alfertshofer
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  3. Konstantin Frank
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  6. Kristina Davidovic
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  7. Robert H. Gotkin
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  10. Sebastian Cotofana
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Corresponding author

Correspondence to Sebastian Cotofana.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

The study was approved by the ethics committee of University of Belgrade, Serbia, under the approval number: 9V08J20SR0352/2020. The study was conducted in accordance with regional laws and good clinical practice.

Informed Consent

Study participants were informed about the aims and the methodology of this study and provided written informed consent for the use of their personal and their 3D facial imaging data for research purposes.

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Hernandez, C.A., Alfertshofer, M., Frank, K. et al. Quantitative Mobility Analysis of the Face and its Relevance for Surgical and Non-surgical Aesthetic Facial Procedures. Aesth Plast Surg 46, 2237–2245 (2022). https://doi.org/10.1007/s00266-022-02921-8

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  • DOI: https://doi.org/10.1007/s00266-022-02921-8

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