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Twenty Years Of Facial Skeletal Aging: Regional Rate Changes Through Longitudinal 3d Ct Analysis
Melih K. Sifil, M.D., David Kahn, MD.
Stanford University, Palo Alto, CA, USA.
Purpose: Cross-sectional studies suggest non-linear facial skeletal aging, but longitudinal evidence is lacking. This study quantifies acceleration of skeletal change using three-dimensional CT scans at three time points over two decades.
Methods: 21 subjects (11 males, 10 females) underwent standardized CT imaging at three time points: T1 (mean age 45.5 years), T2 (mean age 56.3 years), and T3 (mean age 65.4 years). Twenty-one anthropometric measurements across four facial regions were obtained. Acceleration was calculated as the difference in rate of change between T1→T2 and T2→T3 intervals. Mixed-effects models tested for significant acceleration with α=0.05.
Results: 8 of 21 parameters (38.1%) demonstrated statistically significant acceleration (p<0.05). Orbital aperture area showed the greatest acceleration (10.65 mm2/year2, p<0.001), followed by mandibular angle (0.64°/year2, p=0.008). Ramus height demonstrated significant negative acceleration (-0.33 mm/year2, p<0.001), shifting from minimal change to rapid decline. Sex-specific patterns emerged: males showed greater orbital aperture expansion (+177.0 mm2 vs +119.5 mm2 from T2→T3), while females demonstrated greater ramus height decline (-4.6 mm vs -2.8 mm). The pyriform angle showed subtle biphasic reversal (0.23°/year2, p=0.018).
Conclusions: Facial skeletal aging accelerates, with region-specific patterns emerging after the sixth decade. These findings challenge linear aging assumptions and provide quantitative evidence for optimizing timing of facial rejuvenation interventions. The identification of acceleration phases enables predictive rather than reactive approaches to facial aging management.
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