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06-05-2024 | Computed Tomography | Original Articles

Analysis of Anatomy and Age-related Changes in Infraorbital Cheek Using Computed Tomography

Authors: Mengyuan Jiang, Hao Shao, Qingchun Li

Abstract

Background

There is no consensus regarding age-related facial anatomical changes. In this study, aging-related changes in soft and hard cheek tissues were quantitatively analyzed using computed tomography.

Methods

We performed a retrospective study of 90 Asian females who underwent facial computed tomography. Three-dimensional model of soft tissue in apple zone was reconstructed, and age-related changes in fat volume and pyriform aperture area were quantified using Mimics software.

Results

The apple zone is an aesthetic unit of the infraorbital cheek, with soft tissue located between the lateral wall of the pyriform aperture and the zygomatic major muscle. The superficial fat volume significantly decreased with age (P < 0.05). In contrast, a significant decrease in total fat volume was only observed between the young and old groups (P < 0.05). In linear regression modeling, age was a significant predictor of pyriform aperture area (R² = 0.194, P < 0.001).

Conclusions

These results suggest that superficial fat atrophy and bone remodeling in the cheek with age, and both of which combine to contribute to an aging facial appearance.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Wu WTL, Liew S, Chan HH, Ho WWS, Supapannachart N, Lee HK, Prasetyo A, Yu JN, Rogers JD (2020) Consensus on current injectable treatment strategies in the Asian face. Aesthet Plast Surg 44(4):1195–1207CrossRef

Rohrich RJ, Ghavami A, Constantine FC, Unger J, Mojallal A (2014) Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg 133(6):756e–767eCrossRefPubMed

Rohrich RJ, Afrooz PN (2019) Finesse in face lifting: the role of facial fat compartment augmentation in facial rejuvenation. Plast Reconstr Surg 143(1):98–101CrossRefPubMed

Rho NK, Chang YY, Chao YY, Furuyama N, Huang PYC, Kerscher M, Kim HJ, Park JY, Peng HLP, Rummaneethorn P, Rzany B, Sundaram H, Wong CH, Yang Y, Prasetyo AD (2015) Consensus recommendations for optimal augmentation of the Asian face with hyaluronic acid and calcium hydroxylapatite fillers. Plast Reconstr Surg 136(5):940–956CrossRefPubMed

Liew S (2015) Ethnic and gender considerations in the use of facial injectables: Asian patients. Plast Reconstr Surg 136(5 Suppl):22s–27sCrossRefPubMed

Cui H, Wang G (2023) Minimally invasive approach to facial rejuvenation: the authors’ preferred approach. Clin Plast Surg 50(1):1–9CrossRefPubMed

Hamra ST (1995) Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 96(2):354–362CrossRefPubMed

Little JW (2000) Volumetric perceptions in midfacial aging with altered priorities for rejuvenation. Plast Reconstr Surg 105(1):252–266CrossRefPubMed

Binder WJ, Azizzadeh B (2008) Malar and submalar augmentation. Facial Plast Surg Clin North Am 16(1):11–32CrossRefPubMed

10.

Swift A, Remington K (2011) BeautiPHIcation^™: a global approach to facial beauty. Clin Plast Surg 38(3):347–377CrossRefPubMed

11.

Mayes AE, Murray PG, Gunn DA, Tomlin CC, Catt SD, Wen YB, Zhou LP, Wang HQ, Catt M, Granger SP (2010) Ageing appearance in China: biophysical profile of facial skin and its relationship to perceived age. J Eur Acad Dermatol Venereol 24(3):341–348CrossRefPubMed

12.

Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB (2021) The facial aging process from the “inside out.” Aesthet Surg J 41(10):1107–1119CrossRefPubMed

13.

Rohrich RJ, Avashia YJ, Savetsky IL (2021) Prediction of facial aging using the facial fat compartments. Plast Reconstr Surg 147(1s–2):38s–42sCrossRefPubMed

14.

Cotofana S, Gotkin RH, Morozov SP, Kim SY, Gombolevskiy VA, Laipan AS, Pyatnitskiy IA, Movsisyan TV, Frank K (2018) The relationship between bone remodeling and the clockwise rotation of the facial skeleton: a computed tomographic imaging-based evaluation. Plast Reconstr Surg 142(6):1447–1454CrossRefPubMed

15.

Shirakabe Y, Suzuki Y, Lam SM (2003) A new paradigm for the aging Asian face. Aesthetic Plast Surg 27(5):397–402CrossRefPubMed

16.

Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 119(7):2219–2227CrossRefPubMed

17.

Rohrich RJ, Pessa JE, Ristow B (2008) The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg 121(6):2107–2112CrossRefPubMed

18.

Rohrich RJ, Arbique GM, Wong C, Brown S, Pessa JE (2009) The anatomy of suborbicularis fat: implications for periorbital rejuvenation. Plast Reconstr Surg 124(3):946–951CrossRefPubMed

19.

Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J (2012) Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg 129(1):263–273CrossRefPubMed

20.

Jang MS, Kim HY, Dhong HJ, Chung SK, Hong SD, Cho HJ (2015) An analysis of Asian midfacial fat thickness according to age group using computed tomography. J Plast Reconstr Aesthet Surg 68(3):344–350CrossRefPubMed

21.

Katina S, McNeil K, Ayoub A, Guilfoyle B, Khambay B, Siebert P, Sukno F, Rojas M, Vittert L, Waddington J, Whelan PF, Bowman AW (2016) The definitions of three-dimensional landmarks on the human face: an interdisciplinary view. J Anat 228(3):355–365CrossRefPubMed

22.

Surek CK, Vargo J, Lamb J (2016) Deep pyriform space: anatomical clarifications and clinical implications. Plast Reconstr Surg 138(1):59–64CrossRefPubMed

23.

Cotofana S, Gotkin RH, Frank K, Koban KC, Targosinski S, Sykes JM, Schlager M, Schlattau A, Schenck TL (2019) The functional anatomy of the deep facial fat compartments: a detailed imaging-based investigation. Plast Reconstr Surg 143(1):53–63CrossRefPubMed

24.

Mendelson BC, Jacobson SR (2008) Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clin Plast Surg 35(3):395–404CrossRefPubMed

25.

Little JW (2000) Three-dimensional rejuvenation of the midface: volumetric resculpture by malar imbrication. Plast Reconstr Surg 105(1):267–285CrossRefPubMed

26.

Lambros V (2007) Observations on periorbital and midface aging. Plast Reconstr Surg 120(5):1367–1376CrossRefPubMed

27.

Cevik Cenkeri H, Sarigul Guduk S, Derin Cicek E (2020) Aging changes of the superficial fat compartments of the midface over time: a magnetic resonance imaging study. Dermatol Surg 46(12):1600–1605CrossRefPubMed

28.

Boehm LM, Morgan A, Hettinger P, Matloub HS (2021) Facial aging: a quantitative analysis of midface volume changes over 11 years. Plast Reconstr Surg 147(2):319–327CrossRefPubMed

29.

Moghadam S, Roca Y, LaGuardia JS, Huang KX, Chin MG, Bedar M, Fadich SK, Lee JC (2023) Duration of feminizing hormone therapy on facial fat volumes. Plast Reconstr Surg.

30.

Shaw RB Jr, Kahn DM (2007) Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg 119(2):675–681CrossRefPubMed

31.

Feng WJ, Li FW, Zhan WF, Lin FC, Luo SK (2020) Three-dimensional analysis of age-related orbital and midfacial bone remodeling in Asians. Dermatol Surg 46(12):e139–e145CrossRefPubMed

32.

Ko AC, Korn BS, Kikkawa DO (2017) The aging face. Surv Ophthalmol 62(2):190–202CrossRefPubMed

33.

Regensburg NI, Kok PH, Zonneveld FW, Baldeschi L, Saeed P, Wiersinga WM, Mourits MP (2008) A new and validated CT-based method for the calculation of orbital soft tissue volumes. Invest Ophthalmol Vis Sci 49(5):1758–1762CrossRefPubMed

34.

Tower JI, Seifert K, Paskhover B (2019) Patterns of superficial midfacial fat volume distribution differ by age and body mass index. Aesthet Plast Surg 43(1):83–90CrossRef

Title: Analysis of Anatomy and Age-related Changes in Infraorbital Cheek Using Computed Tomography
Authors: Mengyuan Jiang
Hao Shao
Qingchun Li
Publication date: 06-05-2024
Publisher: Springer US
Keywords: Computed Tomography
Computed Tomography
Published in: Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-024-04093-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of Anatomy and Age-related Changes in Infraorbital Cheek Using Computed Tomography

Abstract

Background

Methods

Results

Conclusions

Level of Evidence IV

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of Evidence IV

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