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Original Investigation
April 4, 2019

Long-term Patterns of Age-Related Facial Bone Loss in Black Individuals

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
  • 2Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
JAMA Facial Plast Surg. 2019;21(4):292-297. doi:10.1001/jamafacial.2019.0028
Key Points

Question  What are the patterns of bony changes in the aging face experienced by black individuals observed over time?

Findings  In this cohort study of 20 black adults observed for an average 10-year period, there was a significant increase in piriform aperture width and female orbital width and a decrease in frontozygomatic junction width. There were no significant changes in maxillary or glabellar angles or male orbital width.

Meaning  Although significant longitudinal changes in the facial skeleton can be observed in black individuals, they are less dramatic than those found in previous studies of white individuals, findings that seem to correlate with overall aging trends in bone mineral density.


Importance  Facial skeletal changes that occur with aging have critical importance to the aesthetics of the aging face and the field of facial rejuvenation. Patterns of bony change may differ based on race, but existing research is limited primarily to white or unspecified racial populations.

Objective  To longitudinally document patterns of facial skeletal change among black individuals.

Design, Setting, and Participants  This retrospective case series study evaluated the medical records of patients treated at an urban tertiary medical center and with at least 2 facial computed tomographic (CT) images obtained at least 6 years apart between 1973 and 2017. All patients were self-identified black adults initially aged 40 to 55 years with no history of facial surgery who required repeated facial CT imaging that included the entire midface and cranium. All data analysis took place between August 1, 2018, and October 31, 2018.

Main Outcomes and Measures  Facial CT scans were analyzed for 2-dimensional measurements to document changes in glabellar angle, bilateral maxillary angles, frontozygomatic junction width, orbital width, and piriform width.

Results  A total of 20 patients were included in our analysis (6 men, 14 women). The patients’ mean (SD) initial age was 46.8 (5.8) years, with a mean (SD) follow-up of 10.7 (2.9) years. There was a significant increase in mean (SD) piriform aperture width from 3.24 (0.37) cm to 3.31 (0.32) cm (P = .002) and mean (SD) female orbital width from 3.77 (0.25) cm to 3.84 (0.19) cm (P = .04). There was a significant decrease in mean (SD) frontozygomatic junction width from 5.46 (1.38) mm to 5.24 (1.42) mm (P < .001). No significant differences were found in glabellar angles, maxillary angles, or male orbital width between initial and final imaging time points.

Conclusions and Relevance  This study is the first to our knowledge to document longitudinal bony changes of the face among a population of black individuals. Although significant facial skeletal changes can be observed over an average 10-year period, they are minor in comparison to previously published data among whites. This study suggests that there may be significant differences in facial bony aging between races which may have an impact on the aesthetics of aging and hold implications for facial rejuvenation.

Level of Evidence  NA.