P11. Demystifying Facial Bony Changes With Aging: AI-assisted Analysis of 564 Faces
S.H. Hussein, Jess D. Rames, Jonathan M. Morris, Abdallah A. Shehab, Alexandre Meira Pazelli, Basel A. Sharaf · Plastic & Reconstructive Surgery Global Open · 2025
PURPOSE: Much emphasis has been placed on bony resorption as a contributor to facial aging. But does the facial skeleton resorb significantly with aging? This study employs advanced 3D analysis to comprehensively assess age-related facial bony changes among White/Caucasian and Black/African populations. METHODS: A retrospective analysis of 564 CT scans, categorized by age (20-39, 40-59, and 60-79 years) and gender, was conducted. Ai-assisted segmentation was then used to obtain 3D models and population-level averages of midfacial and mandibular topology by statistical shape modeling (SSM). Linear measurements, angles, and volume changes were then assessed. Moreover, longitudinal sample of 8 individuals was used to validate the SSM methodology. RESULTS: Both populations showed significant age-related increase in orbital foramen widths, with Black/African males displaying the largest increase (8 mm, p<0.001). Pyriform and maxillary angles contracted in both groups (p<0.005), while mandibular angles increased (p=0.00). Heatmaps volume analyses confirmed lateral orbital walls resorption and midface profile flattening. Bigonial widths expanded by 5-7 mm with age in the White population (p<0.001), but remained stable in the Black population. Mandibular rami heights decreased by 4-5 mm in males and females (p=0.00), respectively. Female SSMs exhibited greater bone resorption than their male counterparts in both populations, highlighting distinct gender-aging differences. Lastly, 10-year analysis of 16 male CT scans confirmed SSM’s reliability in capturing age-related changes. CONCLUSION: This study underscores that bone remodeling, rather than simple bone resorption, drives facial aging. Such findings underscore population-specific approaches in site-targeted facial contouring and tailored aesthetic care to patient’s anatomical needs.