Comparison of sagging at the cheek and lower eyelid between male and female faces

Background: Facial sagging is a well-known morphological feature associated with aging and reduced dermal elasticity. Its morphological characteristics and mechanism have been studied in females, but it is unclear whether or not there is a gender difference. Aims: The aim of this study was to clarify the morphological characteristics of sagging and the mechanism of sagging formation in male faces as compared with female faces, focusing on changes in dermal elasticity. Methods: Faces of 98 healthy Japanese male volunteers, in their 20s-60s, were photographed at an angle of 45 degrees. Upper and lower cheek sagging severity was evaluated by using photograph-based grading criteria. In addition, new photograph-based grading criteria of sagging severity at the lower eyelid were established and used. Dermal elasticity was measured using a non-invasive, in vivo suction skin elasticity meter, Cutometer (R). Furthermore, photographs of 108 healthy Japanese female volunteers in their 20s-60s were used to compare the difference in the morphological characteristics of sagging between males and females. Results: Male facial sagging was prominent at the lower eyelid, upper cheek and lower cheek. Sagging severity in the upper and lower cheek was almost the same between males and females at all ages, whereas sagging at the lower eyelid in males was significantly more severe than that in females after middle age. Although dermal extensibility (U(f)) was not related to age, total deformation recovery (U(a)), - (amount of deformation) - (U(f) - U(a)), overall elasticity of the skin including creep and creep recovery (U(a)/U(f)), net elasticity excluding viscoelastic creep (U(r)/U(e)), ratio of elastic recovery to total deformation (U(r)/U(f)) and - (ratio of viscoelastic to elastic distention) - (U(v)/U(e)) were all significantly negatively related to age in both men and women. Furthermore, as in female faces, male facial sagging was significantly negatively related to dermal elasticity parameters, such as - (U(f) - U(a)), U(a)/U(f), U(r)/U(e) and U(r)/U(f). Conclusion: These results indicate that the morphology and areas of sagging in male faces are similar to those in females in the cheek, but sagging at the lower eyelid is more severe in males after middle age. Furthermore, the dermal elasticity of male facial skin decreased with age similar to that of females, and may therefore be associated with the sagging formation in male faces.