Analysis of Anatomy and Age-related Changes in Infraorbital Cheek Using Computed Tomography.

BACKGROUND: There is no consensus regarding age-related facial anatomical changes. In this study, aging-related changes in soft and hard cheek tissues were quantitatively analyzed using computed tomography. METHODS: We performed a retrospective study of 90 Asian females who underwent facial computed tomography. Three-dimensional model of soft tissue in apple zone was reconstructed, and age-related changes in fat volume and pyriform aperture area were quantified using Mimics software. RESULTS: The apple zone is an aesthetic unit of the infraorbital cheek, with soft tissue located between the lateral wall of the pyriform aperture and the zygomatic major muscle. The superficial fat volume significantly decreased with age (P < 0.05). In contrast, a significant decrease in total fat volume was only observed between the young and old groups (P < 0.05). In linear regression modeling, age was a significant predictor of pyriform aperture area (R2 = 0.194, P < 0.001). CONCLUSIONS: These results suggest that superficial fat atrophy and bone remodeling in the cheek with age, and both of which combine to contribute to an aging facial appearance. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Revisiting the "Puffed Cheek" Technique: Advantages, Fallacies, and Potential Solutions.

The "puffed cheek" technique is routinely performed during CT neck studies in patients with suspected oral cavity cancers. The insufflation of air within the oral vestibule helps in the detection of small buccal mucosal lesions, with better delineation of lesion origin, depth, and extent of spread. The pitfalls associated with this technique are often underrecognized and poorly understood. They can mimic actual lesions, forfeiting the technique's primary purpose. This review provides an overview of the puffed cheek technique and its associated pitfalls. These pitfalls include pneumoparotid, soft palate elevation that resembles a nasopharyngeal mass, various tongue displacements or distortions that obscure tongue lesions or mimic them, sublingual gland herniation, an apparent exacerbation of the airway edema, vocal cord adduction that hinders glottic evaluation, and false indications of osteochondronecrosis in laryngeal cartilage. Most stem from a common underlying mechanism of unintentional Valsalva maneuver engaged in by the patient while trying to perform a puffed cheek, creating a closed air column under positive pressure with resultant surrounding soft-tissue displacement. These pitfalls can thus be avoided by instructing the patient to maintain continuous nasal breathing while puffing out their cheek during image acquisition, preventing the formation of the closed air column. Keywords: CT, Head/Neck © RSNA, 2024.

Volume Redistribution of the Buccal Fat Pad After Reduction Malarplasty.

BACKGROUND: During reduction malarplasty, cheek bulging could be found immediately after zygomatic complex is moved inwards, backwards and upwards. As patient is in the supine position during surgery, the effect of gravity is eliminated, so the only reason for the bulge is the redistribution of the soft tissue in the deep facial spaces. The buccal fat pad, with its main body behind the zygomatic arch and buccal extension in the cheek area, is most likely to be responsible for the bulge. METHODS: 3D buccal extension models were reconstructed from preoperative and long-term follow-up CT images and the volume measured. By comparing the pre- and postoperative 3D models, the shape deviation of the buccal extension and facial soft tissue can be identified. RESULTS: Eleven patients (22 buccal extensions) met the inclusion criteria. Compared with the preoperative buccal extension volume, the postoperative volume increased significantly. By comparing the reconstructed models, the buccal extension volume increase with anteroinferior protrusion can be visually detected, and cheek bulging was clearly identified on the lower face. The bulging area coincided with the projection of the buccal extension on the skin surface. CONCLUSIONS: Reduction malarplasty may cause volume redistribution of the buccal fat pad. Therefore, preoperative assessment of the size of the buccal fat pad based on CT images is recommended. The buccal extension volume increase with anteroinferior protrusion is an important cause of postoperative cheek bulging and should be considered during treatment. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quantification of Facial Fat Compartment Variations: A Three-Dimensional Morphometric Analysis of the Cheek.

BACKGROUND: Cheek contour is a main determinant of facial attractiveness. The aim of this study was to evaluate the relationship between age, sex, and body mass index (BMI) and cheek fat volume in a large cohort to better understand and treat facial aging. METHODS: The authors performed a retrospective review of the archives of the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen. Epidemiologic data and medical history were assessed. Cheek superficial and deep fat compartment volumes were measured on magnetic resonance images. Statistical analyses were performed using SPSS and SAS statistical software. RESULTS: A total of 87 patients with a mean age of 46 years (range, 18 to 81 years) were included. The superficial and deep fat compartment volumes of the cheek increased with BMI ( P < 0.001 and P = 0.005), but there was no significant relationship between age and volume. The ratio of superficial versus deep fat did not change with age. No significant difference of the superficial or deep fat compartments was found between men and women in a regression analysis ( P = 0.931 and P = 0.057). CONCLUSIONS: Cheek fat volume measurements on magnetic resonance imaging scans using reconstruction software suggest that the fat volume of the cheek increases with BMI but does not change significantly with age. Further studies are needed to elucidate the role of age-related changes of bone structures or sagging of the fat compartments.

Ultrasonography in the Assessment of Tumors of the Cheek: Water Mouth Distension Technique.

PURPOSE: To describe a new B-mode ultrasound examination technique to assess cheek tumors. MATERIALS AND METHODS: 30 cheek oral cavity lesions of different histological types (11 benign and 19 malignant) from 23 patients (11 women and 12 men, 7-82 years old, mean age of 49.5 years) were analyzed. Transcutaneous oral B-mode ultrasound (5-12 MHz transducer) was carried out in two stages. Initially it was performed conventionally with an empty mouth. Next, the patient was asked to keep their oral cavity filled with water (like when using a mouthwash) during imaging for the new test examination technique. The anatomical layers of this region and the characteristics of the tumors were evaluated. Lesions were classified as ill defined, partially defined, or defined. Conventional findings were compared to those of the new technique using the Wilcoxon signed-rank test. Ultrasound results were compared to histological findings analyzed by an independent team. RESULTS: The conventional empty mouth technique was able to confidently define lesion extension in only 6 of the 30 lesions, while the water-filled mouth technique was able to confidently define lesion extension in 29 of the 30 lesions (p<0.00001). CONCLUSION: We present a novel technique that dramatically improves ultrasound staging of cheek oral cavity tumors. In addition to the increase in ultrasound accuracy, this technique does not require any special equipment or extra cost, is very well tolerated by patients, and thus should be considered in the evaluation of every patient undergoing transcutaneous cheek ultrasound for oral cavity lesion characterization.

Assessment of clinical and ultrasonographic parameters as indicators for buccal fat pad excision by esthetic reasons.

PURPOSE: The selection of candidates for buccal fat pad (BFP) removal depends on the patient's requirements, the subjective surgeons' evaluation, and objective clinical factors. This cross-sectional observational study aimed to identify objective clinical and ultrasonographic parameters as indicators of cheek contouring with BFP excision. METHODS: Sixty-six patients with cheek fullness complaints were examined by two experienced surgeons to determine if they were good candidates for the procedure. Thereafter, participants underwent clinical and ultrasonographic assessments in a separate session to aid in the surgical decision-making. The association between the clinical judgment for BFP excision and the study variables was analyzed individually and adjusted for confounders using binary logistic regression and grouping analyses. RESULTS: Forty-nine participants were regarded as suitable and 17 as non-suitable for the procedure. After regression analysis, cheek skin-fold thickness > 6.00 mm, midfacial contour > 2.20 mm, ovoid/triangular facial form, and ultrasonographic BFP volume > 2.05 mL remained as robust individual indicators for the suitability for the procedure. However, the grouping analysis showed that patients having three-to-four significant criteria synchronously had significantly higher odds for eligibility with excellent discrimination capability. CONCLUSION: Although high values of cheek skin-fold thickness, midfacial contour, and ultrasonographic BFP volume, as well as an ovoid/triangular facial form, might be robust indicators for the suitability for BFP excision, the surgical decision-making should not be based on isolated parameters. Instead, those patients possessing a combination of at least three of these specific eligibility criteria above the threshold value might be considered the best candidates for the procedure.

The Importance of Ultrasound in Excision of the Buccal Fat Pad.

Partial excision of the buccal fat pad is a surgery indicated for different functional and aesthetic procedures. Although this surgery offers minimal risks, the ultrasound examination can provide security in performing the surgery, in addition to predicting preoperative anatomical variations and assisting in the treatment of postoperative complications. With the worldwide search for aesthetic procedures, concomitant with the development of imaging tests that help in different diagnoses and treatments, ultrasonography has become an excellent indication for planning oral fat pad surgeries.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Refining Orthognathic Surgery Results by Synchronous Cheek Fat Compartment Augmentation with Fat Grafting in Adult Females with Class III Skeletal Profiles.

SUMMARY: Patients with maxillomandibular disharmony may present with a flat to concave midface. The effects of orthognathic surgery concomitant with midface fat grafting on facial appearance and midface volumetric and positional change have not formally been assessed to date. The authors' approach for synchronous orthognathic surgery and fat grafting is described and evaluated. Adult female patients (n = 20) who underwent synchronous two-jaw orthognathic surgery and cheek-specific fat grafting (1.9 ± 0.6 cm3 per side) for correction of skeletal class III deformity and anteromedial cheek deficiency were prospectively included. Preoperative and postoperative photographs were appraised by 42 blinded raters using facial appearance scales for beauty, attractiveness, and pleasantness parameters. The three-dimensional midface soft-tissue volume change and postoperative cheek mass position were computed. Facial imaging data from gender-, ethnic-, and facial pattern-matched adult patients (n = 20) who underwent isolated two-jaw orthognathic surgery (n = 20) were included for comparison. The three-dimensional facial norms database-derived cheek mass position information (2.19 ± 1.31mm) was also adopted for analysis. Patients treated with the synchronous procedure had significantly (p < 0.001) increased facial appearance-related perception change for beauty (2.9 ± 1.6), attractiveness (2.8 ± 1.8), and pleasantness (3.0 ± 1.5) parameters, three-dimensional midface volume change (1.8 ± 0.5 cm3), and postoperative cheek mass position (2.16 ± 0.47 mm) in comparison with those treated with the isolated procedure (2.0 ± 1.5, 1.9 ± 1.6, 2.3 ± 1.6, 0.6 ± 0.2 cm3, and 1.84 ± 0.43 mm, respectively). Healthy female individuals had similar and larger cheek mass position than patients treated with synchronous (p > 0.05) and isolated (p < 0.001) procedures, respectively. Synchronous orthognathic surgery and check-specific fat grafting resulted in superior enhancement of facial appearance and midface volume and position compared with isolated orthognathic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Cheek soft tissue prediction in cleft orthognathic surgery: A 3D computer-assisted investigation with comparative analysis.

BACKGROUND: The Le Fort I maxillary advancement and rotational movement have been adopted to treat patients with cleft-related skeletal Class III pattern and anteromedial cheek soft tissue deficiency, but cleft-specific cheek soft tissue prediction data are insufficient. This 3D imaging-based study addressed the issue. METHODS: 3D craniofacial soft tissue and bone models were created from 32 consecutive patients who received computer-aided two-jaw orthognathic surgery for the correction of cleft-related Class III deformity and cheek soft tissue deficiency. Using superimposed 3D models, the cheek volumetric change, the cheek sagittal movement, and the 3D cheek mass position were calculated. 3D data from orthognathic surgery-treated patients with no cleft (noncleft cohort) and individuals with no facial deformity (3D norm value) were retrieved for comparative analysis. RESULTS: Surgical maxillary advancement (p < 0.001) but not maxillary clockwise rotation (p > 0.05) had a significant impact on the cheek soft tissue change, with prediction models showing that maxillary advancement elucidated 77 and 79% of this change on the cleft and noncleft sides, respectively. Cleft cohort (0.46±0.12) had a significantly (p < 0.001) smaller cheek soft-to-hard tissue ratio than that of the noncleft cohort (0.73±0.13). Cleft maxillary advancements >4 mm resulted in a 3D cheek mass position (2.1±1.1 mm) similar (p > 0.05) to the 3D norm value (2.2±1.2 mm), but different (p = 0.037) from the noncleft cohort (2.38±0.7 mm). CONCLUSION: This study showed that maxillary advancement but not the maxillary rotation affects the cheek soft tissue change, and the predictive values and comparative data could assist the orthodontist-surgeon interaction during preoperative planning and patient counseling.

Relaciones anatómicas del cuerpo adiposo de la mejilla asociadas a complicaciones de bichectomía: a propósito de un caso / Anatomical relationships of the adipose buccal fat pad associated with bichectomy complications: about a case

RESUMEN: El presente estudio busca entregar conocimientos y aspectos importantes de las estructuras anatómicas asociadas al cuerpo adiposo de la mejilla (CAM), a consecuencia del reporte de un caso de complicación posterior a una bichectomía. Conocer los elementos anatómicos y sus relaciones con el CAM es de vital importancia, ya que en la actualidad son muchos los cursos y pasadas que se realizan para odontólogos generales y especialistas para el retiro del CAM, esto producto de la creciente demanda estética de las personas por presentar un perfil más fino y estilizado. El caso presentado corresponde a una mujer que consultó al servicio de urgencia por aumento de volumen facial posterior a la extracción del CAM, el cual se diagnosticó como sialocele, consecutivo a daño del conduc- to parotídeo. Al revisar la literatura y observar en nuestros preparados anatómicos se aprecia la cercanía de elementos de importancia, como son el conducto parotídeo, los ramos cigomático y bucal del nervio facial, vasos faciales como la arteria facial, vena facial y arteria transversa facial, es por esto que es necesario conocer en detalle la zona a intervenir y considerar las posibles variaciones anatómicas de estos elementos, para así evitar dañarlos durante el procedimiento, tomando una actitud preventiva. Apuntado entonces al objetivo de este estudio, fue lograr entregar información anatómica precisa y concisa de los elementos de importancia próximos o inmersos en el CAM, para prevenir la iatrogenia de estos.

SUMMARY: The present study seeks to provide knowledge and important aspects of the anatomical structures associated with the buccal fat pad (BFP), as consequence of the report of a case of complication after bichectomy. Knowing the anatomical elements and their relationships with BFP is of vital importance, because nowadays there are too many BFP removal courses and internships, for general dentists and specialists, due to the increasing aesthetic demands of individuals seeking a finer and more stylized profile. The case presented is a female patient who consults the emergency department for an increase in facial volume after BFP extraction, which was diagnosed as sialocele, following damage to the parotid duct. When reviewing the literature and observing our anatomical preparations, the proximity of important elements is appreciated, such as the parotid duct, the zygomatic and buccal branches of the facial nerve, facial vessels such as the facial artery, facial vein and facial transverse artery. It is essential to know in detail the area in order to intervene and consider the possible anatomical variations of these elements to avoid injury during the procedure. The aimed objective of this study, is to provide accurate and concise anatomical information of important elements near or immersed in BFP, to prevent iatrogenesis.

Facial UV photo imaging for skin pigmentation assessment using conditional generative adversarial networks.

Skin pigmentation is associated with skin damages and skin cancers, and ultraviolet (UV) photography is used as a minimally invasive mean for the assessment of pigmentation. Since UV photography equipment is not usually available in general practice, technologies emphasizing pigmentation in color photo images are desired for daily care. We propose a new method using conditional generative adversarial networks, named UV-photo Net, to generate synthetic UV images from color photo images. Evaluations using color and UV photo image pairs taken by a UV photography system demonstrated that pigment spots were well reproduced in synthetic UV images by UV-photo Net, and some of the reproduced pigment spots were difficult to be recognized in color photo images. In the pigment spot detection analysis, the rate of pigment spot areas in cheek regions for synthetic UV images was highly correlated with the rate for UV photo images (Pearson's correlation coefficient 0.92). We also demonstrated that UV-photo Net was effective for floating up pigment spots for photo images taken by a smartphone camera. UV-photo Net enables an easy assessment of pigmentation from color photo images and will promote self-care of skin damages and early signs of skin cancers for preventive medicine.

Anatomic Characteristics and Treatment of the Midcheek Groove by Deep Filling.

BACKGROUND: Because the anatomic mechanisms underlying the formation of the midcheek groove are unclear, treatments to date have resulted in unsatisfactory outcomes. OBJECTIVE: This study investigated the anatomical foundation of the midcheek groove and evaluated appropriate treatment methods. MATERIALS AND METHODS: Six cadaver hemifacial specimens were subjected to gross anatomic dissection and 6 to P45 sheet plastination. Based on the anatomic results, the area under the orbicularis oculi muscle (OOM) was selected for deep filling. Patients were evaluated by measuring 3D depth, regrading, and self-assessment. RESULTS: The medial band was observed to be an important structure of the OOM, with the facial projection overlapping the midcheek groove trace. Two of the 6 P45 specimens were found to have compact fibroelastic bundles (CFBs) between the medial band and the dermis. Deep filling of the area under the OOM significantly reduced the depth of each section in all 34 patients (p < .001). Grades 3 and 4 midcheek grooves were downgraded distinctively. Most subjects expressed satisfaction with outcomes. CONCLUSION: Formation of the midcheek groove is associated with the passage of CFBs. Deep filling of the area under the OOM effectively improves the midcheek grooves.

Vertical Midface Lifting: An Improved Technique for Asians.

BACKGROUND: Treatment of the aging midface is increasingly deemed a key part of facial and periorbital rejuvenation. Compared with Westerners, Asians tend to have a relatively prominent zygoma and mandibular angle, thicker dermis, and greater propensity for scar formation. OBJECTIVE: This study was performed to review our surgical method of vertical midface lifting in Asian patients and evaluate the clinical outcomes. METHODS AND MATERIALS: This retrospective observational study involved 116 Asian women who complained of an aged midface. All patients underwent midface rejuvenation surgery with one lower eyelid incision and 2 small frontal-temporal incisions. Clinical results were assessed objectively using photographs and subjectively by a patient satisfaction survey. RESULTS: All patients recovered well without major complications. High patient satisfaction (94%) was attained. The improvement scores as evaluated by the panel demonstrated a higher level of improvement for the malar eminence (8.3 ± 0.6), nasojugal groove (8.0 ± 0.8), and nasolabial fold (7.9 ± 0.7) than for the lower face (6.2 ± 1.0). CONCLUSION: Our vertical midface lift technique is safe and effective for older Asian patients with a midface aging appearance. LEVEL OF EVIDENCE: Therapeutic IV.

Differences in the shape and direction-course of the nasopalatine canal among dentate, partially edentulous and completely edentulous subjects.

We aimed to analyze the nasopalatine canal shape and anatomical variations of the buccal bone wall and compare the effect of the presence or absence of the central maxillary incisors on the nasopalatine canal. The shape of the nasopalatine canal and the dimensions of the buccal bone wall were measured in 150 patients who underwent a cone-beam computed tomography study. We found that the most prevalent shape of the nasopalatine canal was funnel (31%) and the most common direction-course was slanted-straight (33%). The buccal bone wall in relation to the nasopalatine canal was thickest at the anterior nasal spine level and narrowest at the level of the most anterior-inferior point of the buccal cortex of the maxilla. A statistically significant difference was detected between morphology and direction-course of the nasopalatine canal and dental status. In sum, the study of the nasopalatine canal showed multiple variations. Precise knowledge of these variations may help to decrease the incidence of complications during implantology treatment and during facial and dental surgery.

Filler Migration and Florid Granulomatous Reaction to Hyaluronic Acid Mimicking a Buccal Tumor.

Hyaluronic acid is among the most commonly used cosmetic fillers. Although considered biocompatible and safe, it may rarely cause a wide range of complications. The authors report a case of migration of hyaluronic acid concomitant with granulomatous inflammatory response that mimicked a buccal tumor. A 52-year-old female presented with a solid painless mass of the right buccal area. The patient denied any history of trauma and cosmetic procedures of the affected area. Skin and mucosal membrane were intact and the lesion was firm and well fixed in the deep plane. Due to worrisome clinical presentation and the patient's history of breast cancer, the lesion was excised radically. Histopathological examination revealed multiple granulomas surrounding amorphous lakes of hyaluronic acid. During repeated, thorough anamnesis the patient admitted having underwent lip augmentation and nasolabial fold correction with HA two years before, after which the filler must have migrated posteriorly. Physicians need to be aware of various complications associated with cosmetic fillers as they may mimic severe clinical conditions.

Validation of two handheld devices against a non-portable three-dimensional surface scanner and assessment of potential use for intraoperative facial imaging.

BACKGROUND: The aim of this study was to compare accuracy and timing of two handheld, mobile three-dimensional surface imaging (3DSI) devices against an established non-portable medical imaging system, and to evaluate future intraoperative use for facial surgery. METHODS: Surface-to-Surface root mean square analysis was used to evaluate both a consumer device (Sense 3D) and a professional surface scanner (Artec Eva) against a reference imaging system (Vectra XT). Two assessors repeatedly 3D-imaged the facial region of an imaging phantom and 30 volunteers in two separate sessions. Using both mobile devices, intraoperative 3DSI of 10 rhinoplasty patients was compared with preoperative reference imaging. Intraclass Correlation Coefficient was calculated for repeated measurements. RESULTS: Artec Eva yielded mean deviations below 0.5 mm for the whole face and all subunits excluding the eye region. Sense 3D showed similar deviations for the whole face, but otherwise only in the central and lateral forehead unit and the medial cheek. Variability was low for both the non-portable Vectra XT and Artec Eva, whereas full-face assessment using Sense 3D resulted in high variability. When compared to the preoperative reference images, intraoperative rhinoplasty 3DSI revealed low deviations for Artec Eva and high deviations for Sense 3D. CONCLUSIONS: The 3D surfaces captured by Artec Eva showed a similarly desirable accuracy for facial imaging as Vectra XT reference images. This handheld device presents a suitable option for the objective documentation during rhinoplasty surgery. Sense 3D was unable to accurately capture complex facial surfaces and is therefore limited in its usefulness for intraoperative 3DSI.

Deep Cheek Fat Volumes and Midfacial Aging.

BACKGROUND: Midfacial volumizing procedures are increasingly common in facial rejuvenation. However, the changes that occur in midfacial fat with aging are poorly understood. OBJECTIVES: The aim of this study was to determine how deep cheek fat volume is predicted by age. METHODS: We conducted retrospective cross-sectional and longitudinal studies of patients based on facial computed tomography (CT) scans. In the cross-sectional cohort, multiple linear regression analysis was performed to model the relations between age and deep cheek fat volumes. In the longitudinal analysis, changes to deep cheek fat volumes were tracked among subjects who underwent multiple facial CT scans. RESULTS: The cross-sectional cohort comprised 109 patients. The mean (SD) age of the subjects was 59.7 (15.0) years (range, 21.7-91.1 years). A linear regression analysis showed that increasing age was associated with increasing deep cheek fat volume (ß = 0.015, P < 0.001). Additional regression analyses showed that the gain of fat with aging was more pronounced in the caudal aspect of the cheek (ß = 0.007, P < 0.001) than in the cephalad (ß = 0.005, P < 0.001). Twenty-three subjects were identified for longitudinal analysis. The mean (SD) ages at initial and final imaging time points were 50.0 (5.8) and 60.3 (5.2) years. In the deep fat compartment, there was an average gain of 0.23 mL over 10.3 years (P = 0.03). CONCLUSIONS: Age is an important predictor of midfacial deep cheek fat volume. In this study, there is no evidence of adipose volume loss in the deep cheek compartment. Rather, aging was associated with an increase in deep cheek fat, possibly reflecting pseudoherniation of buccal fat.

Difference in Midface Rejuvenation Strategy Between East Asians and Caucasians Based on Analysis of Age-related Changes in the Orbit and Midcheek Using Computed Tomography.

BACKGROUND: The differences between Caucasian and East Asian faces could lead to different age-related bony changes. We analyzed computed tomography (CT) scan images of East Asians to find objective differences in midface rejuvenation strategy between East Asians and Caucasians. METHODS: We reviewed 54 East Asian individuals' charts and facial CT images ranging in age-group: Group A (21-30 years), Group B (41-50 years), and Group C (61-70 years). No patients had congenital or acquired facial deformity and history of facial trauma. The anteroposterior length of the orbital roof and floor (LOR, LOF) and the angle of the anterior wall of the maxilla were recorded on parasagittal images through the midline of the orbit. RESULTS: The LORs at their midpoints showed significant differences between Groups A and B (p < 0.01). The LOFs were also significantly different between Groups A and B (p < 0.001). The difference in the angle between the anterior maxillary wall and the orbital floor was not significant between Groups A and B. The lengths between Groups B and C showed no significant differences. CONCLUSION: Our study demonstrated that the aging process in East Asians differs considerably from that in Caucasians, with characteristic significant changes in LOF and LOR. Since the aging process is different, the strategies to cope with aging should also differ. Volume restoration of the inferior orbital rim in the midface is one of the most important rejuvenation methods in East Asians. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.