Val Lambros m.d., f.a.c.s.

cosmetic and reconstructive surgery

3D Facial Averaging: A Breakthrough

In 2004, I got access to a 3D camera (Vectra, Canfield scientific). This remarkable instrument images all the surface points of the face in space and constructs a 3D model, which one can rotate and take very accurate measurements on. These cameras show exceptional detail of the skin surface as well — the latest versions will let you visualize individual pores. In 2005, while walking past the company’s booth at a plastic surgery meeting, I had the idea of using it to look at individual plastic surgeons as they aged. It seemed to be a reasonable idea at the time, since plastic surgeons come back to plastic surgery meetings at regular intervals and one could follow individual faces as they aged. I collected images for the next 11 years, getting follow-up images at five-year intervals, and then at three-year intervals. I have about 1400 images now. Much could be written about this time. But after eight years or so, it became apparent that my subjects were getting old too slowly and I was getting old much too fast.

Since 3D information is digital — numbers — it can be analyzed mathematically. In late 2015, software became available that could average 3D images. And with this, the scope of the study changed overnight. What I could now do is average all the faces of a certain gender and age and compare them both numerically and visually. Because they were aligned in the process of averaging, the old faces and the young faces could be placed in an identical relationship with each other, so one could see how the face changed geographically, and what moved.

The Results

These are not simulations, this is the actual process of facial aging in the population I studied. It has not been seen before. To my knowledge, these are the only rigorous images of facial aging based on pictures in the literature. They are difficult to do, but they give a structured and geographic picture of what actually happens with age.

The images are an average of a huge amount of mathematical data represented visually. To my knowledge, this has not been done before, though I expect it will be repeated once the software and cameras become more widely available.

In November 2016, Plastic and Reconstructive Surgery will publish an introductory discussion of my research into these images. Check back for a pdf of the article after publication.

This is new technology and these images may change slightly over time as the data get reexamined in different ways. I am convinced enough of the truth of these images to present them now.

The animations shown here are of the average face of 127 young women animated with the average face of 117 women from 68 and up. Only the central face is shown in these particular images, in them you can see about 50 years of facial aging in less than a second. You should study them for a while. The more you look the more you see.

It has long been known that the eyes seem to get smaller as one ages, and here you can see why. The entire lid aperture gets smaller because the lower lid rises, the upper lid falls and the lid gets shorter from the side. Most plastic surgeons have not been aware of the lower lid rising, as the kind of patients they see in the clinic frequently have lower lids which droop. But the averages show what happens in the general population.

The border between the lid and the cheek may descend a small amount, but as you see in these images, they're remarkably stable. You can see the fat pads enlarge. What happens in life here is that the color and texture of the eyelid skin changes and the fat pads protrude, making the border seem more apparent. In the face, in-and-out looks like up-and-down.

The nose and lips are the most surprising. People have long been aware that the upper lip lengthens with age. But here we can see the relationships in the entire central face.

The lower lip doesn’t drop so much as shrink. The point that marks the vermilion (red) border of the lower lip really doesn’t move much. In fact, it rises. The entire central lower lip mass gets thinner and seems to move upwards. The base of the nose by the nostrils (the alar base) moves backwards, upwards and to the side. I had seen this happen in some people by just comparing photographs, but I had no idea it was prevalent enough to appear in the averages.

The biggest change in the old face is at the corner of the mouth(!). There is a large fat pad between the corners of the mouth to the nasolabial fold. The entire lip is firm with fibrous fat. With age, the corner of the mouth recedes backwards into the face. This is not visible from the front because the motion is directly backwards, but is very visible from below (as well as the quarter view and the lateral view). This is largely what drives the formation of the nasolabial fold in this area. It is only partially the cheek "descending" toward the mouth. A lot of it is from the entire lip unit receding.

There are many lessons to be learned here. One is that what you think happens is not always what is actually happening. People think of the aging face as falling, and in part it does. But there are areas of the face that expand and contract. And it is that expansion or contraction that makes it look like things are descending.

Pulling the cheeks has looked better to vast empires of women since the invention of the mirror. Though the face may be made to look better by doing so, there are other factors that must be attended to as well.

In this picture you can see a color map. What you are seeing is the older average face. The younger face is invisibly placed on top and the difference between the two is in color. Red is farther away and blue is closer. So when you see the red lips and corner of the mouth, this means those areas are farther away, ie smaller than the younger face. The blue areas, like the lower lid fat pads and the jowls, are bigger.