AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Factors Contributing to Senescent Facial Changes in Monozygotic Twins
Bahman Guyuron, MD, Adam Bryce Weinfeld, MD, Yashar Eshraghi, MD, Amir Hassan Fathi, MD, Seree Iamphongsai, MD.
Case School of Medicine, Cleveland, OH, USA.

Purpose: Genetic factors, environmental exposures, and social and medical history contribute to facial aging. The purpose of this study is to identify and quantify the effect of the non-genetic determinants of facial aging in North American women by evaluating monozygotic twin pairs for correlations between intra-pair differences in those determinants and differences in facial appearance.
Methods: Eighty female monozygotic twin pairs were included in this study. Participants completed a 4-page questionnaire designed to characterize environmental exposures and social and medical history. Anterior-posterior, oblique, and profile digital photographs were taken of each subject. A 4-member panel evaluated the photographs and rated differential facial aging between twins in the unit of years. The perceived age differential was statistically correlated with differences in questionnaire responses to identify and quantify the non-genetic factors that contribute to facial aging. Multiple linear regression was used to identify independent variables (environmental exposures, social history and medical history) that have a statistically significant effect on facial aging by assessing their affect on perceived age difference in years between twin pairs.
Results: The age range was 18 to 76 years old (mean 45.6 standard deviation 18.0). Five percent of the participants were African American. The remaining subjects were Caucasian. Increased number of years smoking history (coefficient = 0.19, T-Value = 5.9) and a history of skin cancer (coefficient = 3.21, T-Value = 1.92) increased perceived facial age. Increases in BMI (coefficient = -2.77, T-Value = -2.81) and number of years of hormone replacement (coefficient -0.10, T -Value = -1.98) decreased perceived facial age. The following general linear model describes 40% of the differential in facial age seen:
PFAI = 0.55 yrs + SmkYrs (0.19yrs) +SkinCa (3.21yrs) - HormYrs (0.10) - BMI(0.277)
PFAI: perceived facial age increase in years
SmkYrs: number of years smoking history
SkinCa: an incidence of a skin cancer
HormYrs: number of years of hormone replacement
BMI: body mass index
Conclusion: This study identifies four non-genetic determinants of facial aging. These include smoking and history of skin cancer which increase perceived facial age and increases in BMI and hormone replacement which decrease perceived facial age. Fore example, based on the linear model above, twenty years of smoking increases facial age by 3.8 years. Thus, the anticipated facial aging affect of smoking is now quantified. The aging affect of skin cancer identified may suggest that skin cancer is a powerful marker for sun exposure, an accepted age-increasing environmental exposure. BMI decreased perceived facial aging. This finding is aligned with contemporary theory suggesting that volume depletion is a stigma of facial aging and bolsters the role of volume restoration as a powerful component in the facial rejuvenation armamentarium. Longitudinal studies of the sample population are planned to further define facial aging determinants.

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