Val Lambros m.d., f.a.c.s.

cosmetic and reconstructive surgery

The Facial Aging Project

The reader should be lucky that he or she doesn’t have to listen to dermatologists, filler injectors and surgeons talk about how the face ages. One will hear the most spectacularly unsupported opinions and visual prejudices offered as immortal truths.

With some reflection, one will recognize this as an entirely human characteristic. Like the blind men and the elephant, doctors will understand facial aging by the way that they treat it. Put another way, plastic surgeons, because they do operations which are very effective at removing fat and tightening skin, see facial aging as a process of descent, stretch, and accumulation of fat. This is partially correct.

Dermatologists don't have surgical tools and will focus on small wrinkles, skin discoloration and the changes they can make in wrinkles, or by paralyzing muscles, and improving skin tone and coloration. They see facial aging as a process of skin deterioration. This is also partially correct.

Injectors think everything needs to be filled. This is emphatically not true.

The scientific data on facial aging seems to reflect the prejudices of the people writing the articles. Artists can do depictions but these are also based on the prejudices of the artist.

The problem is that there hasn’t been a rigorous way of getting a complete picture of facial aging. It's frustrating. We are surrounded by faces of all ages but it's very hard to follow them through time in a scientific way.

Starting in the late 1980's, I began to ask people to bring in old photographs of themselves just to see how they used to look. In 2000, I had the idea of carefully matching old photos to a newly taken ones, aligning the two, and comparing the images visually. Not side by side, but as an animation, with one image fading to the other.

This is the first image I put together this way. This particular image was imperfect, as she is smiling and the two images are not exactly in the same position, but the method seemed promising.

My goal became to get an accurate picture of how the face ages by matching old and new photographs. I thought this was going to be easy. Ha! It proved to be very difficult. The problems with doing analysis this way is what scientists call "garbage in, garbage out." If the old and young pairs of pictures are not from the same angle, and the expression is not the same, and the distance to the camera is not the same, and if the images are not precisely registered to landmarks on the face that don’t move, one could easily come to false conclusions. It is not enough to take a phone picture of yourself every day and think that you have shown anything of value.

I became very focused. I had patients bring old photos in to their consultations. I would go to friends’ houses and zero in on the old family pictures. I bothered relatives for old photos. Matching photographs is very difficult. Since people are smiling in most of their personal pictures, most personal pictures are not valuable for this study. The smallest smile distorts the face and pushes the cheeks and lower lids up.

Worse, getting a new picture to match is very difficult. Essentially, I had to guess or figure out where the camera was in relation to the face 40 years prior and try to duplicate that. I wound up using a brute force method, trying to make my best guess as to camera position, and then taking 15-20 pictures around that spot. Since my research method is very sensitive to changes in position, a very small amount of change in relative position of the two images made for a big apparent change when animated.

An occasional present came via the internet (an example of which you will see in the lips page), when I could find the very rare young/old image pairs that were close enough to animate.

Nonetheless, slow painful progress was made. In 2007, I published a paper discussing the changes around the eyes. This article has a number of animations which the reader can click on. You'll get to see them in this section.

See my findings

The pages linked here represent a very brief summary of what I found out about facial aging from the matched photographic series. The images on these pages relate most to Caucasians, the group I have studied the most. Within, we will talk about facial shape, volume and borders.