Assessment of Craniofacial Fat Layer Thickness and Its Asymmetry in Relation to Sex and Age: Forensic and Anthropological Perspectives – Northwest Indian Population

Background: Craniofacial fat layer thickness (CFLT) shapes facial contour and volume and is therefore critical for accurate forensic facial reconstruction, anthropological analysis, and clinical facial procedures. Population-specific reference data are scarce for Northwest India. To quantify CFLT at 73 craniofacial landmarks and to examine sex- and age-related variation and right–left asymmetry in a Northwest Indian adult cohort. Materials and Methods: This retrospective, crosssectional study analyzed craniofacial computed tomography (CT) scans from 1560 adults (770 males, 790 females) aged 18–80 years, stratified into six age groups. Fat layer thickness was measured perpendicular to the underlying bone at 73 standardized midline and bilateral landmarks using Syngo.via (Siemens). Each landmark was measured in triplicate by two independent observers; mean values were used for statistical analysis. Right–left differences, sex differences, and age trends were assessed using paired and independent t -tests, oneway ANOVA with Tukey post hoc comparisons, and Pearson correlation coefficients. Measurement reliability was evaluated by technical error of measurement (TEM) and relative TEM (rTEM). Analyses were performed in SPSS v23, and significance was set at P < 0.05. Results: Mean CFLT varied markedly by landmark. Midsagittal values ranged from 2.28 mm (Metopian) to 11.79 mm (Stomion). Males showed greater thickness at most midline and periorbital sites, whereas females exhibited relatively higher thickness at several posterior alveolar and molar landmarks. Age effects included progressive thickening of specific midline and perioral sites through middle age (peak ~46–55 years), followed by plateauing or modest decline in older decades. Right–left asymmetry was small overall but statistically significant at a subset of molar, occlusal, and periocular points. Correlation analyses showed strong associations between sex and CFLT, moderate associations with age, and high bilateral concordance across paired landmarks. Conclusion: This CT-based dataset constitutes the first comprehensive, age- and sex-stratified reference for CFLT in the Northwest Indian population. The observed sex- and age-dependent patterns and the high midline symmetry support the use of midsagittal landmarks in forensic reconstruction and reinforce the need for sex- and age-specific adjustments when modelling lateral facial regions.