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      Quantitative 3-dimensional Geometry of the Aging Eyelids

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          Background:

          Although facial aging is a well-known phenomenon, it has not been comprehensively characterized in 3 dimensions. This study introduces a novel technique for capturing periorbital structures across age groups using 3-dimensional (3D) imaging and point cloud data collection.

          Methods:

          Forty-six white women were divided into 3 age groups: 20–39 years, 40–59 years, and 60+ years. Patients were scanned with the Canfield 3D photogrammetry system, and data files were exported to the point cloud processing software CloudCompare. Manually selected points specifying eyelid margins, creases, and 5 key periorbital features provided the basis for a fitted model and principal component analysis (PCA). Potential statistical significance across age groups was assessed for PCA values corresponding to each subject's eyelid geometry.

          Results:

          Three tendencies emerged with respect to increasing age and eyelid anatomy: the width and height of the palpebral fissure decreases, with the width decreasing more rapidly; the depth of the lateral canthus relative to the medial canthus decreases; and the superior crease becomes more variable. Analyses of variance of PCA values across age groups show statistically significant differences between the youngest and oldest groups.

          Conclusions:

          Three-dimensional photogrammetry enables rigorous and reliable evaluation of the aging eyelid. Results suggest age-induced changes to eyelid margin, crease, and lateral canthus positions, which have been noted anecdotally but poorly quantified until now.

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          Most cited references16

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          Observations on periorbital and midface aging.

          Many of the anatomical changes of facial aging are still poorly understood. This study looked at the aging process in individuals linearly over time, focusing on aspects of periorbital aging and the upper midface. The author compared photographs of patients' friends and relatives taken 10 to 50 years before with closely matched recent follow-up pictures. The best-matching old and recent pictures were equally sized and superimposed in the computer. The images were then assembled into GIF animations, which automate the fading of one image into the other and back again indefinitely. The following findings were new to the author: (1) the border of the pigmented lid skin and thicker cheek skin (the lid-cheek junction) is remarkably stable in position over time, becoming more visible by contrast, not by vertical descent as is commonly assumed. (2) Orbicularis wrinkles on the cheek and moles and other markers on the upper midface were also stable over decades. (3) With aging, there can be a distinct change in the shape of the upper eyelid. The young upper lid frequently has a medially biased peak. The upper lid peak becomes more central in the older lid. This article addresses these three issues. No evidence was seen here for descent of the globe in the orbit. There seems to be very little ptosis (inferior descent) of the lid-cheek junction or of the upper midface. These findings suggest that vertical descent of skin, and by association, subcutaneous tissue, is not necessarily a major component of aging in those areas. In addition, the arc of the upper lid changes shape in a characteristic way in some patients. Other known changes of the periorbital area are visualized.
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            Is photogrammetry of the face reliable?

            The reliability of photogrammetry was assessed in 18 healthy young, white Canadians of each sex. Landmarks were indicated on the face before direct measurement and photography. Of 104 surface measurements taken directly from the head, face, and ears of subjects, 62 could be duplicated on the life-size frontal and left lateral photographs taken from the head in standard position. Of these 62 measurements, 26 were reliable (the same as or differing from the direct measurements by no more than 1 mm or 2 degrees). The greatest number of reliable measurements were of the lips and mouth (7 out of 13), but no ear measurements were reliable. Almost half (9) of the reliable measurements were inclinations. More correct vertical measurements were possible from lateral prints than from frontal views, but many lateral facial measurements from profile prints were distorted. Frontal-view prints gave additional reliable measurements.
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              Topographic anatomy of the eyelids, and the effects of sex and age.

              To describe the effects of sex and age on eyeball, eyelid, and eyebrow position. A cross sectional cohort study was performed in which both eyes of 320 normal subjects aged between 10 and 89 years were included. Of each 10 year age cohort, there were 20 men and 20 women. Frontal, as well as lateral, slides were taken of both eyes. On projected slides, a reference line through the medial canthi and vertical lines through the pupil centre and the lateral canthus were constructed. Using these lines, we measured the size of the horizontal eyelid fissure, the distance from the reference line to the pupil centre and to the lateral canthus, the distance between the pupil centre and the upper and lower eyelid margin, and the distance between the upper eyelid margin and the skin fold and eyebrow. On lateral slides, the distance between the lateral canthus and the anterior corneal surface was measured. Between the ages of approximately 12 and 25 years, the horizontal eyelid fissure lengthened 3 mm, while the position of other eyelid structures remained virtually unchanged. Between the average ages of 35 and 85 years, the horizontal eyelid fissure gradually shortened again by about 2.5 mm. Meanwhile, the distance between the lateral canthal angle and the anterior corneal surface decreased almost 1.5 mm. Aging caused an increase of the distance between the pupil centre and the lower eyelid of about 1 mm in men, and 0.5 mm in women. Aging also caused a higher skin crease and raised eyebrows in men and women, but it did not affect the position of the pupil centre and the lateral canthus. Men showed an 0.7 mm larger horizontal eyelid fissure than women. In women, however, the eyebrows were situated about 2.5 mm higher than in men. Aging mainly affects the size of the horizontal eyelid fissure, which lengthens by about 10% between the ages of 12 and 25, and shortens by almost the same amount between middle age and old age. Aging causes sagging of the lower eyelid, especially in men, and a higher skin fold and eyebrow position in both sexes. Aging does not affect the position of the eyeball proper, or of the lateral canthus.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                November 2019
                12 November 2019
                : 7
                : 11
                : e2512
                Affiliations
                From the [* ]The Warren Alpert Medical School of Brown University, Providence, R.I.
                []Vision Systems Inc, Providence, R.I.
                []Division of Plastic Surgery, Mount Auburn Hospital, Cambridge, Mass
                [§ ]Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
                Author notes
                Helena O. Taylor, MD, PhD, 300 Mount Auburn Street, Suite 304, Cambridge, MA 02138, E-mail: htaylor@ 123456mah.harvard.edu
                Article
                00001
                10.1097/GOX.0000000000002512
                6908328
                4f8b501e-4cc9-4a91-a631-c9035c6b6ad5
                Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 19 February 2019
                : 30 August 2019
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