Gravity in Midfacial Aging: A 3-Dimensional Study

BACKGROUND: Volume loss and volume descent are complementary aspects of facial aging, although the respective contribution of each is unclear. OBJECTIVE: To quantify the effects of gravity in the midface between the upright and supine position in three dimensions, in two cohorts. METHODS: A prospective study of 53 female patients who had not undergone dermal fillers or facial cosmetic surgery. Three-dimensional photography using the VECTRA H1 camera (Canfield Scientific, Fairfield, NJ) was taken in supine and sitting position. Volume shifts and displacement of structures in three dimensions were measured and analyzed. RESULTS: Morphologically, upon shifting from sitting to supine position, the tail of the brow elevated, the tear trough filled, the buccal and malar fat shifted posteriosuperiorly, the earlobe decreased in height, the nasiolabial folds and marionette lines diminished, the modiolus shifted laterally, and the jowl diminished. Volumetric analysis revealed that the infraorbital region increased in volume by 0.59 +/- 0.55 mL, the tear trough by 0.22 +/- 0.19 mL, and the malar region by 1.2 +/- 1.06 mL. In supine position, all facial topographic landmarks displaced significantly from sitting position. CONCLUSION: Facial aging was predominantly due to tissue descent rather than volume loss, in the measured cohort. Reversal of the gravitational force restores the three-dimensional position of the facial subunits and leads to volumization in desirable locations that approximate a more youthful appearance. The volume restored via redistribution of facial fat is comparable to that typically injected during direct volume transfer procedures.