Determination of age-related changes in the morphological structure (sagging) of the human cheek using a photonumeric scale and three-dimensional surface parameters

The usefulness of the photo standard for evaluating skin sagging in the face, especially in the cheeks, was evaluated. A six-stage photo standard was prepared using photos of women aged 17-83-years-old at three magnification rates (136-188 women in each group). Based on this photo standard, scoring was performed using a six-grade scoring system by two specialists to obtain the consensus score. Scoring was also performed in parallel by five general observers. The degree of agreement between the two scores was evaluated by calculating the Kappa value. In each group, the Kappa value was 0.452-0.563, indicating moderate agreement. Thus, the photo standard may be useful for evaluating sagging. Based on the photo standard, a score of 2, at which sagging becomes detectable appeared at the age of 40 years. In parallel, 3D analysis of replicas around the cheek was performed to morphologically analyse age-related changes in sagging. When the depth parameter was compared between the nasolabial groove and the mouth corners, a higher value was observed in the nasolabial groove until the age of 40 years, but higher values were seen in the mouth corners thereafter. This may have been because sagging in the cheeks descends to the area around the mouth, resulting in reversion in the sWv value. These findings indicated that sagging in the cheeks becomes morphologically distinct in women in their forties.