Study on the Aging Dynamics of the Periorbital Region: From Observation to Knowledge of Physiopathology

Background: Several anatomical and physio-pathological studies of eyelid region have allowed the creation of theories on facial tissues aging dynamics, which have not been clarified yet. We assessed the signs of aging in the region over the time by observing the characteristics in the same person at different times of his/her life.

Methods: We compared the position of the main anatomical landmarks of the eyelid region of 80 patients by overlaying their photos when they were 20, 40 and 60 years old. By creating a fade in the photos, we produced an overlap of the faces (using a software) getting the correspondence of eyes, nose and mouth position. The signs we observed were the following ones: position of the medial and lateral portions of the eyebrow, presence of ptosis, accentuation of frontal wrinkles, width of the eyelid, presence of the upper and lower eyelid bags, presence of upper dermatochalasis, elongation of the lower eyelid height, position of the lateral canthus, highest point of the upper eyelid arc and the presence of the naso-jugal groove. The images were evaluated by a team composed of two plastic surgeons and two ophthalmologists.

In order to find age-related differences for each patient, we divided the overlapping images in 3 groups: 20-40, 40-60 and 20-60 years.

The Stuart-Maxwell test and multinomial logistic regression for repeated measures were used to analyze the data.

Results: we observed, as age increases, the position of the medial portion of the eyebrow tends to be higher and the lateral portion of the eyebrow tends to be lower. In almost half of them there was the presence of a more or less accentuated form of upper eyelid's ptosis in the photo at 60 years. About the accentuation of frontal wrinkles, it is clear that this defect increases its incidence starting from the age of 40 years in both sexes (p<0.05).

There were changes in the horizontal dimension of the palpebral fissure: in fact seems to be shortening after 40 years, both for males and females (p<0.05).

The position of lateral canthus appeared lower in about one-third of patients photographed at 60, but it was stable in those photographed at 40. We didn't observe a significant difference in herniation of the upper eyelid bags between groups and sexes. Both dermatochalasis of the upper eyelid and elongation of the lower eyelid height were present in subjects after 40 years, with a statistically significant difference compared to the group 20-40 and more in women (p<0.05). Furthermore, the presence of the nose-jugal groove appears more in women over 40 years (p<0.05).

Conclusion: we have highlighted some interesting elements, partly agreeing with the data already recorded by other authors' and our data suggest an important role of the eyelid structures senescence and its impact on the surrounding structures

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