Aging Changes of the Male Lips—A Lesser Evil Than in Females?

Anthropometry and Current Aesthetic Concept of the Lower Third of the Face and Lips in Caucasian Adult Population: A Systematic Review and Meta-Analysis

BACKGROUND

The lack of standardization of the norms and aesthetic concept of the lower third of the face and lips creates challenges in reconstructive surgery and aesthetic procedures. A large-scale, anthropometric measurements summary poses an alternative for establishing universal patterns.

METHODS

A systematic review was conducted by searching PubMed, Embase, Google Scholar and Web of Science using keywords: lip, face, aesthetics, beauty, anthropometry and Caucasian. Seventy records were included in the review and checked in detail in terms of available data.

RESULTS

The study contains a meta-analysis of twelve parameters with sufficient quantitative data-lip width, nose width, facial width, lower third of the face height, midline mandible height, total height of the upper and lower lip, upper and lower vermilion height, cutaneous upper lip height and nasolabial and mentolabial angle.

CONCLUSIONS

The review provides a detailed database of primary anthropometric studies of lips and perioral regions of the healthy Caucasian population. The attractiveness of the region is focused on uniformity of proportions. Notably, results acquired with different methods of measurement are not interchangeable. Despite many published anthropometric studies, systems for conducting the measurements and reporting the results are not sufficiently unified to quantitatively assess meticulous key aesthetic clinical parameters.

LEVEL OF EVIDENCE I

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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Gender- and Age-Related Characterization of Lip Morphology: A Three-Dimensional Analysis in a Chinese Population

BACKGROUND

Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment.

OBJECTIVES

This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol.

METHODS

Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients.

RESULTS

Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results.

CONCLUSIONS

Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries.

LEVEL OF EVIDENCE: 4

Impact of subnasal lip lift on lip aesthetic: a systematic review

This study is to perform a systematic review of the literature on surgical correction of the upper lip in order to assess whether the subnasal lip lift technique improves lip aesthetics and maintains its stability. A systematic search was carried out using the PubMed, Science Direct, Scopus, Cochrane Library and EMBASE databases, based on records published until July 2020. The quality of the included studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. In the absence of randomized clinical trials, prospective or retrospective cohort studies, case control and case series were considered eligible. Of the 464 articles initially found by the two reviewers, 4 were selected, with 2 retrospective cohorts and 2 case series. The results of the studies showed that 92.4% of subnasal lip lift cases were performed in women with an age range between 21 and 65 years (mean of 36.6 years). Only one of the 4 studies did not contain information regarding the sex and age of the patients. The bull's horn excision pattern for subnasal lip lift was used to perform the subnasal lip lift in 75% of the included studies. All studies pointed to an improvement in lip aesthetics after the subnasal lip lift, based on anthropometric measures and the degree of patient satisfaction while maintaining results for varying periods of time (from 12 to 59.1 months). The studies included in this review suggest that the subnasal lip lift improves lip aesthetics in adult patients and maintains its stability for a certain period of time.

Age-Related Changes in Facial Soft Tissue of Han Chinese: A Computed Tomographic Study

BACKGROUND

Facial lifting and volume restoration are the major strategies of facial rejuvenation, but the aging of facial soft tissues has not been sufficiently explored.

OBJECTIVE

This study aimed to reveal the age-related changes in full facial soft tissue of Han Chinese by using computed tomography.

MATERIALS AND METHODS

The measurements were performed on head computed tomographic images of 200 Han Chinese subjects (100 men and 100 women). The thickness of facial soft tissue was measured at 20 anthropological landmarks of the skull.

RESULTS

The thickness at rhinion was increased, whereas the thickness at midphiltrum, supradentale, and infradentale was decreased, indicating the significant differences in both sexes. Besides, the thickness at glabella, nasion, supramentale, and menton was decreased significantly in women. The thickness at supraorbital and lateral orbit was increased with aging in either sex. The thickness at frontal eminence, infraorbital, supraglenoid, and gonion showed significant age-related increases in women, and the thickness at zygomatic arch, supra M2, and infra M2 was significantly decreased in men.

CONCLUSION

These results suggest that soft tissues in different areas of the face are selectively thickened or thinned with aging, thus providing a reference for rejuvenation procedures.

A combined method of oral commissure lifting for perioral rejuvenation in Asians

BACKGROUND

A drooping oral commissure shows an appearance of ageing and sadness. To improve it with less complications has become a rising aesthetic concern for Asians.

OBJECTIVES

To share our method for oral commissure lifting by a combined technique including skin resection, oral commissure suspension, and dissection of the depressor anguli oris muscle (DAO), and to present the follow-up outcomes.

METHODS

This was a retrospective study of patients who underwent oral commissure lifting between 10/2012 and 03/2019 at the Department of Plastic Surgery, Peking University Third Hospital. The patients were routinely followed at 1 week, 1 month, and over 6 months. After operation, cases with the cheilions (oral commissure points) located above the ipsilateral lateral thickening points were considered to be effective, with the points at the same level were considered to be mildly effective, and with the cheilions below the ipsilateral lateral thickening points were considered to be ineffective treatment.

RESULTS

Surgery took around an hour. Swelling subsided within 9.2±3.4 days. The red color of the scar disappeared within 3.7±1.5 months and the natural facial expression was restored within 7.9±2.6 weeks. Among the 159 cases, 125 (78.6%) were obviously effective, 21 (13.2%) were mildly effective, and 13 (8.2%) were ineffective. After the first operation, 112 patients (70.4%) were satisfied, 39 patients (24.5%) were basically satisfied, and eight patients (5.0%) were unsatisfied.

CONCLUSIONS

The combined technique for the oral commissure lifting displayed a significant effect with little complication in Asian patients.

Aging of the Upper Lip: Part I: A Retrospective Analysis of Metric Changes in Soft Tissue on Magnetic Resonance Imaging

BACKGROUND

In scientific literature, numerous theories on the mechanism of facial aging can be found. The debate about facial sagging versus deflation is still ongoing. In this study, the metric changes in perioral soft tissue were demonstrated. These data can contribute to a better understanding of physical changes in the aging perioral area.

METHODS

Upper lip measurements were performed on cranial magnetic resonance images of 200 Caucasian subjects (100 men and 100 women). The study population was aged between 20 to 30 and 65 to 80 years. The upper lip length and soft-tissue thickness were measured on sagittal and parasagittal section. Cross-section surface area of the upper lip was measured in the sagittal section to represent volume. The data were analyzed with a t test and results were considered significant at p < 0.01.

RESULTS

The upper lip in the old age group differed significantly in length (19.24 percent in women and 18.24 percent in men), thickness (up to -40.55 percent in women and -32.74 percent in men), and volume (-20.89 percent in women and -17.40 percent in men). Soft-tissue thickness at the alar nasolabial fold was significantly thinner in the old age group (-25 percent in women and -25.7 percent in men) and showed significantly greater tissue loss than elsewhere in the upper lip (p < 0.001).

CONCLUSIONS

These results suggest that the aging perioral area is affected with a combination of soft-tissue lengthening, thinning, and volume loss. The clinical implications of this study on perioral rejuvenating strategies will be explained in part II.

Prostacyclin does not affect sweating but induces skin vasodilatation to a greater extent in older versus younger women: roles of NO and KCa channels

NEW FINDINGS

What is the central question of this study? It remains unknown whether ageing modulates prostacyclin-induced cutaneous vasodilatation in women. What is the main finding and its importance? Prostacyclin induced cutaneous vasodilatation, albeit the magnitude of increase at lower concentrations of prostacyclin was greater in older relative to young women. This response was associated with greater contributions of nitric oxide synthase and calcium-activated potassium channels. Our results suggest that administration of prostacyclin might be an effective therapy to reverse microvascular hypoperfusion, especially in older women. We previously reported that prostacyclin induces cutaneous vasodilatation but not sweating in younger and older men. Furthermore, we demonstrated that nitric oxide synthase and calcium-activated potassium (K_Ca ) channels contribute to the prostacyclin-induced cutaneous vasodilatation in younger men, although these contributions are diminished in older men. Given that the effects of ageing might differ between men and women, the above results cannot simply be applied to women. In this study, cutaneous vascular conductance and sweat rate were evaluated in younger (mean ± SD, 22 ± 3 years old) and older (55 ± 7 years old) women (10 per group) at four intradermal forearm skin sites treated as follows: (i) lactated Ringer solution without any drug (control); (ii) 10 mm N^G -nitro-l-arginine (l-NNA), a non-specific nitric oxide synthase inhibitor; (iii) 50 mm tetraethylammonium (TEA), a non-specific K_Ca channel blocker; or (iv) 10 mm l-NNA plus 50 mm TEA. All four sites were co-administered with prostacyclin in an incremental manner (0.04, 0.4, 4, 40 and 400 μm, each for 25 min). Surprisingly, increases in cutaneous vascular conductance in response to 0.04-4 μm prostacyclin were greater in older relative to younger women (all P ≤ 0.05), and these age-related differences were diminished when both l-NNA and TEA were administered simultaneously (all P > 0.05). No effect on sweat rate was observed in either group (all concentrations, P > 0.05). We show that although prostacyclin does not mediate sweating, it induces cutaneous vasodilatation, and this response elicited by lower concentrations of prostacyclin is greater in older relative to younger women. This greater cutaneous vasodilatation in older women is likely to be attributable to nitric oxide synthase- and K_Ca channel-dependent mechanisms.