The "Brown sisters": photogrammetric analysis of brow and cheek descent.

BACKGROUND: Due to the absence of accurate tools and appropriate photographic material there is a paucity of objective studies on facial aging in the modern literature. OBJECTIVES: To measure changes in two elements of the face: brow ptosis and cheek mass migration, using an objective tool that we developed which we then used to evaluate facial aging in two subjects studying serial professional photographs over a 25 year period. METHODS: We studied the photographic atlas of the "Brown Sisters," a record of the yearly group photograph of four sisters taken by the photographer Nicolas Nixon. For technical reasons only two of the sisters fulfilled the criteria we set for the study. We used the interpupillary distance of each photograph studied to standardize the brow height and cheek mass distance from the interpupillary line. RESULTS: We observed progressive medial brow descent occurring at about the age of 30, with apparent stabilization thereafter. In contrast, there was a continuous process of lateral brow descent through the years. A process of gradual cheek mass descent was noted in the second half of the third decade. CONCLUSIONS: Our results indicate that the dynamic brow changes start in the second half of the third decade, with more significant lateral brow descent than medial brow descent. The cheek mass reflective point moves in an inferior-lateral direction. The tool we developed can be used to follow aging changes and postoperative results, thereby helping the surgeon achieve true rejuvenation surgery.