Synchronized aging trajectory of facial and skeletal morphology in Chinese females: implications for rejuvenation strategies

Background: Aging is a multifactorial process involving both facial and skeletal changes. Understanding the chronological morphological changes in both skeletal and soft tissues is crucial for clinical practice but remains underexplored. This study aimed to visualize synchronized skeletal and facial aging trajectories via geometric morphometrics, providing a clearer understanding of how to optimize personalized rejuvenation strategies. Methods: A cohort of 348 healthy Chinese females was analyzed using cranio-maxillofacial CT and 3D surface imaging in this retrospective study. Phenotypic extractions for skeletal and facial morphologies were conducted using 53 skeletal landmarks and a topological template. The participants were divided into six age groups for chronological comparisons. Geometric morphometrics were used to visualize age-related morphological variations and generate aging trajectories, verifying the correlation between skeletal and facial aging. Results: Facial and skeletal aging were significantly correlated (coefficient: 0.34, P = 0.001). Skeletal aging is characterized by height reduction, inferolateral orbital resorption, maxillary protrusion, and pyriform aperture contraction, beginning at 20 years of age and accelerating at 40 years of age. Facial aging manifested as height and width reduction, periorbital ptosis, asymmetric midfacial sagging with fat redistribution, and philtrum elongation, beginning at 30 years and accelerating at 35 years. Compared with Caucasians, Chinese females exhibited distinctive maxillary counterclockwise rotation with age. Conclusions: Skeletal and facial aging are interrelated but occur asynchronously, with skeletal aging preceding soft tissue changes. The rapid acceleration of facial aging at approximately 35 years highlights the need for early intervention, with a focus on preserving skeletal structure before 40 years of age to maintain facial harmony. Skeletal rejuvenation and soft tissue restoration should be considered in tandem, particularly in the midface and jawline regions, for effective and long-lasting rejuvenation outcomes. This study underscores the clinical importance of early, anatomy-informed interventions tailored to age-related changes to enhance clinical decision-making and optimize personalized rejuvenation strategies.