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. 2024 Sep;48(18):3568-3576.
doi: 10.1007/s00266-024-04070-6. Epub 2024 May 9.

Understanding the Interplay Between Skin, Fascia, and Muscles of the Midface in Facial Aging

Konstantin Frank  1 , Nicholas Moellhoff  2 , Nina Engerer  2 , Kai O Kaye  1 , Michael Alfertshofer  2 , Robert H Gotkin  3 , Samuel Kassirer  4 , Charlotte Weinmann  5 , Gabriela Casabona  1 , Sebastian Cotofana  6   7
Affiliations

Understanding the Interplay Between Skin, Fascia, and Muscles of the Midface in Facial Aging

Konstantin Frank et al. Aesthetic Plast Surg. 2024 Sep.

Abstract

Background: Surgical, minimally-invasive, and non-invasive aesthetic procedures try to ameliorate the signs of facial aging, but also focus on enhancing various individual features of beauty in each patient. Herein, the midface plays a central role due to its location but also its importance for the aesthetic perception and facial expression.

Objective: To date, no study has investigated the interplay between facial muscles and its connecting subdermal architecture during facial aging to provide a more comprehensive understanding of the middle face.

Materials and methods: A total of 76 subjects, consisting of 30 males (39.5%) and 46 females (60.5%) with a mean age of 42.2 (18.7) years [range 19-80] and a mean BMI of 24.6 (3.7) kg/m2 [range 18-35], were enrolled in this investigation. Cutometry (skin aging), 3D skin displacement analyses (subdermal connective tissue aging), and sEMG (muscle aging) analyses were utilized.

Results: The results revealed that overall skin firmness increased, and skin elasticity decreased (p < 0.001), sEMG signal of the investigated muscles decreased (p < 0.001), whereas midfacial mobility remained unaltered (p = 0.722).

Conclusion: The results of this study indicate that midfacial aging is a measurable effect when utilizing individual measurement modalities for assessing skin, subdermal fascia, and midfacial muscles. The function of midfacial muscles revealed a potential threshold effect, which is not reached during midfacial aging due to the unchanged soft tissue mobility at older age. However, to understand its clinical presentation all midfacial soft tissues need to be factored in and a holistic picture needs to be created.

No level assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Keywords: 3D imaging; Aesthetic facial treatments; Cutometry; Electromyography; Facial aging.

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References

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    1. Rudolph C, Hladik C, Stroup DF et al (2019) Are cosmetic procedures comparable to antidepressive medication for quality-of-life improvements? A systematic review and controlled meta-analysis. Facial Plast Surg. https://doi.org/10.1055/s-0039-1697030 - DOI - PubMed
    1. 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. https://doi.org/10.1111/jocd.13245 - DOI - PubMed - PMC

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