Association of Facial Exercise With the Appearance of Aging

Physical manifestations of facial aging are now understood to include not only skin laxity and superficial photodamage but also deeper substructural volume loss of fat and muscle.¹

There has been recent interest in the lay community in facial exercises or facial “yoga” that can rejuvenate the aging face, presumably by inducing underlying muscle growth.^2-4 In this report, we describe what we believe to be the first clinical trial to assess facial exercise as a modality for improving skin appearance.

Healthy participants aged 40 to 65 years with photodamage, associated mild to moderate facial atrophy, and with an interest in facial exercises were included. Participants received formal instruction on 32 facial exercises. All participants attended 2 live 90-minute muscle-resistant facial exercise training sessions with a certified facial exercise instructor (G.S.). Neither participants nor those administering the interventions were blinded. After the initial training sessions with the instructor, participants performed daily 30-minute exercises for 8 weeks at home. During weeks 9 to 20, participants continued practicing exercises every other day (3-4 times per week).

This study was approved by the Northwestern University Institutional Review Board and registered at ClinicalTrials.gov (NCT01689012) prior to participant enrollment. Written informed consent was obtained from all participants. Recruitment and enrollment took place from January to February 2013. Study procedures were from March to July 2013, and data analyses were performed from April to May 2015.

The primary objective was to determine the association of a facial muscle exercise program with the appearance of the face and neck. The secondary objective was to measure participant satisfaction with facial appearance before and after completion of the exercise program.

The primary outcome measure was assessment of standard photographs rated by 2 blinded physicians (M.A., W.R.) using the validated Merz-Carruthers Facial Aging Photoscales (MCFAP).^5,6 The co-primary outcome measure was blinded rater estimation of participant age. A secondary outcome measure was participant satisfaction questionnaire on an 11-point visual analogue scale (0 = not satisfied at all, 10 = extremely satisfied).

Scores on the MCFAP were analyzed using the Wilcoxon signed-rank test as the nonparametric alternative to paired t tests. Data for predicted age and participant satisfaction were analyzed with 2-sided paired t tests. Significance level was set at .05.

Twenty-seven participants were enrolled (33 screened, 33 found to be eligible, 6 declined to enroll). Sixteen received the full 20-week intervention (11 dropped out) and all follow-up visits, and the data from these were analyzed. Demographic and clinical characteristics of participants are displayed in Table 1. Results of the MCFAP are reported in Table 2.

Based on the MCFAP scales (Table 2), facial exercise resulted in improved mean (SD) upper cheek fullness (1.1 [0.6] vs 1.8 [0.7]; P = .003) and lower cheek fullness (0.9 [0.7] vs 1.6 [0.9]; P = .003) at 20 weeks vs baseline. Mean (SD) estimated age decreased significantly when baseline was compared with study end (50.8 [4.8] y vs 48.1 [5.5] y; P = .002). Participants were more satisfied with all facial aging outcomes when baseline was compared with end of study (data not shown).

A 30-minute daily or alternate-day facial exercise program sustained over 20 weeks may modestly improve the facial appearance of selected middle-aged women. Blinded ratings of validated photoscales showed significant improvement in upper and lower cheek fullness. Rater estimates of mean participant age showed a significant monotonic decrease from 50.8 years at baseline to 49.6 years at 8 weeks and 48.1 years at 20 weeks. Participants were highly satisfied, noting significant improvement in 18 of 20 facial features.

This study had limitations that may reduce its external validity. The sample was small, exclusively of middle-aged women, there were numerous dropouts, and there was no control group in the study. Another limitation is that participants were self-selected and may have been particularly willing to continue with an exercise regimen.

In conclusion, a regimen of at-home facial exercises maintained for 20 weeks seemed to improve mid-face and lower face fullness. The mechanism may be exercise-actuated hypertrophy of cheek and other muscles. Further research is warranted to isolate the causes and effects of exercise-related changes and to assess the generalizability of these findings.

Accepted for Publication: October 18, 2017.

Corresponding Author: Murad Alam, MD, MSCI, MBA, Department of Dermatology, 676 N St Clair St, Ste 1600, Chicago, IL 60611 (m-alam@northwestern.edu).

Published Online: January 3, 2018. doi:10.1001/jamadermatol.2017.5142

Author Contributions: Dr Alam had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Alam, Walter, Geisler, Sikorski, Tung.

Acquisition, analysis, or interpretation of data: Walter, Geisler, Roongpisuthipong, Poon.

Drafting of the manuscript: Alam, Geisler, Sikorski, Tung, Poon.

Critical revision of the manuscript for important intellectual content: Walter, Roongpisuthipong, Tung, Poon.

Statistical analysis: Roongpisuthipong, Poon.

Administrative, technical, or material support: Walter, Geisler, Sikorski, Tung.

Study supervision: Alam, Walter, Geisler, Tung.

Funding/Support: This study was supported by departmental research funds, Department of Dermatology, Northwestern University.

Role of the Funder/Sponsor: The funding source participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflict of Interest Disclosures: Dr Alam is employed at Northwestern University. Dr Alam has been a consultant for Amway and Leo Pharma, both unrelated to this research. Northwestern University has a clinical trials unit that receives grants from many corporate and governmental entities to perform clinical research. Dr Alam has been principal investigator on studies funded in part by Allergan, Medicis, Bioform, and Ulthera. All grants and gifts in kind have been provided to Northwestern University and not Dr Alam directly, and Dr Alam has not received any salary support from these grants. Mr Sikorski is the founder of Happy Face Yoga, which was the exercise regimen used for training participants.

Additional Contributions: We are indebted to Jason Sloan, MS (Department of Dermatology, Feinberg School of Medicine, Northwestern University) for helping with initial recruitment; Dennis P. West, PhD (Department of Dermatology, Feinberg School of Medicine, Northwestern University), for helping with the design and regulatory aspect of the study; Karina Colossi Furlan, MD (Department of Dermatology, Feinberg School of Medicine, Northwestern University), for helping edit part of the manuscript; and Emir Veledar, PhD (Emory University School of Medicine and Baptist Health South Florida), for insight into statistical considerations. No compensation was received for such contributions.