by Dr Debraj Shome, Senior Cosmetic Surgeon and Director & Dr. Rinky Kapoor, Cosmetic Dermatologist & Dermato-Surgeon
According to the study Aging and the Indian Face: An Analytical Study of Aging in the Asian Indian Face, that is conducted by The Esthetic Clinics and its reputed Founders Dr Debraj Shome and Dr Rinky Kapoor, Asian Indians make up almost one-sixth of the world’s population. Although some aspects of facial beauty are universal, anthropometric morphology and age-related changes differ in all ethnic groups. This study published in the reputed journal Plastic and Reconstructive Surgery, described various aging patterns amongst Asian Indians. It is the first ever-aging study published on how Indians age and with this iconic study, now deciding actually anti-aging protocols to keep Indians younger will become easier for Indian doctors.
Aging is an ongoing process. However, aging patterns are known to be different in each race. Despite Asian Indians forming almost one-sixth of the world’s population, no data are available on how they age.
“Although some aspects of facial beauty are universal, aesthetic preferences vary amongst different ethnic groups and cultures. This is because of the cosmetic concerns, which differ according to variations in facial bony anatomy, morphology, and skin tones, both at a relatively young age and during aging. Anthropometric features of Indians differ significantly from those of the Caucasian faces. Asian Indian faces are being treated as per the norms derived from Caucasian literature on facial aesthetics. India is a country of immense diversity, culture, different climatic conditions, and geographic locations. In India, regional differences exist in shape and color,” said Dr. Debraj Shome, Cosmetic Surgeon & Director, The Esthetic Clinics
“Earlier, there was no other study conducted to determine how the Indian’s age. This is a one-of-its-kind study to various aging patterns amongst Asian Indians. It will help Indians stay younger, reverse aging by tackling those early signs of aging such as crow’s feet, nasolabial folds, fat bags and loss of cheek volume highlighted Dr. Rinky Kapoor, Cosmetic Dermatologist & Dermato-Surgeon, The Esthetic Clinics
“India is a country of immense diversity, culture, different climatic conditions, and geographic locations. In India, regional differences exist in shape and color that varies from region to region and get exacerbated due to aging. Overall facial height of North, Indians were larger than that of South Indians. Also, the facial width of South, Indians is broader compared to North Indians, in both genders. The people from West Bengal can have broad to very broad faces.” said Dr Shome.
The Causes of aging
“Structural facial aging is mainly caused by volumetric fat loss, skeletal resorption, and redistribution of skin and soft tissue. In a younger face, superficial and deep fat is distributed evenly. With aging, fat loss and hypertrophy cause irregular topographic changes on the face. These changes develop on the temples, cheek, and lateral chin. It further gets enhanced by bone resorption of the mandible and loss of lip volume. All this contributes toward the sagging of the overlying skin, leading to the variability of ethnocentric features of both facial structures and beauty,” said Dr Shome.
Understanding the aging process
“The process of aging is a combination of intrinsic and extrinsic factors. Skin types in Indians can range from Fitzpatrick type II to type VI skin, amongst various Indian regions. The phenotypic variations within India, based on the different geographical regions, cannot be ignored. It is very important to consider all these facts while studying the aging process, as different races age differently. The early signs of aging were seen in Indians in the age group of 35-40,” said Dr Rinky Kapoor.
Following are the aging signs Indians MUST watch out for…
Crow’s feet are the wrinkles usually formed on the lateral aspect of the eyes with aging. During facial expressions, persistent accordion-like contractions of the lateral orbicularis oculi muscle leads to its origin. Ptosis and laxity of the muscle also contribute to the same area were noted as early as 35–40 years of age.
Tear Trough Deformity
The tear trough is a 2–3 cm depression inferior to the pseudo-herniated orbital fat in the lower eyelid. The tear trough defect is a very common esthetic concern in Indians, even at a young age. Indians aged 20–30 years presenting with tear trough deformity mostly requires treatment for the medial hollowness. It may occur due to aging, chronic exposure to sunlight, and tropical temperature. The mean age of occurrence of tear troughs to be 40–60 years, with initial signs as early as 35–40 years. North and East Indian population develop it earlier compared to the West and South Indian ethnic groups
Nasolabial folds can be attributed to the age-related facial sagging, loss of skin elasticity, and adipose tissue accumulation. The nasolabial folds were seen more commonly in women compared to men of the same age group. The folds developed early in East and West Indian ethnicities compared to the North and South Indian populations. Also, it was noticed that the South Indian population shows least nasolabial folds in the older age group of >70 years of age.
With advancing age, commissural skin begins to sag, causing mandibulo-labial folds. This further leads to depression around the corners of the mouth, which we often refer to as marionette lines. This gravity-dependent movement of the malar fat pads coupled with the decrease in the perioral volume as well as deepening of the nasolabial folds shapes the aging midface. 38% of the Indian women over 30 years showed moderately to severely pigmented marionette lines.
Fat Bags and The fullness of Buccal Fat
McCurdy et al. mentioned that there is a substantially lower incidence of fine wrinkles in both darker and more lightly pigmented Asians, due to the increased dermal thickness. This can make lower lids look the looser and make under-eye bags more prominent in 40 years, resulting in an older appearance.
Loss of Cheek Volume Just below Zygomatic Arch
With aging, there is deepening of nasolabial folds, subsequent hollowing of the cheeks, and loss of malar prominence. Also, there is the lengthening of the lower eyelid, increasing visibility of the orbicularis oculi muscle, along with enhancement of tear trough and formation of crescent/ “V”-shaped deformity along the maxilla and zygoma. The recession of the nasal alar cheek junction is also evident, as age advances. Individual fat compartments start becoming more discernible as separate entities rather than transiting smoothly from convexities to concavities as seen in youth.
Jaw Line Prominence and Neck Volume
A youthful jawline is a straight line marked from the chin to the mandibular angle. Increased soft tissue laxity, inferior migration of the jowl fat compartment, and shrinkage of the mandible cause loss of definition of the jawline. Also, with aging, the oval face becomes squarer due to the increase in the neck volume. The loss of prominence is more significant in North Indians followed by West, East, and South Indian ethnic groups.
Dr Shome said, “beauty parameters are mostly influenced by geographical, cultural, and morphological variations, a detailed knowledge of the morphological characteristics of face and aging process of the various geographic groups is crucial. Once the pattern, process, and the areas most affected by aging are known, it is easy to formulate guidelines which suggest the ideal age and the ideal method to carry out a specific cosmetic procedure.”
He added, “The Asian Indian population (as per our study) ages earlier than the reported ages in the Caucasian population (in other studies). This seems counterintuitive, given the melanin content in the Asian Indian skin and counterintuitive from what we have observed in our clinical practice as well.”
This study can open up a gateway for new proposals of enhancing the understanding of the current concepts and techniques in the fields of facial aesthetics and facial cosmetic surgery. It will surely benefit people to age like fine wine,” concluded Dr Rinky Kapoor.