The Contribution of the Lower Third of the Face to Perceived Age: Do Masks Make You Appear Younger?

Nicksic, Peter J; Karczewski, Alison M; Zhao, Qianqian; Garcia, Nicholas A; Michelotti, Brett F; Mahajan, Ashish Y; Poore, Samuel O

BACKGROUND: Extrinsic factors like smoking, alcohol use, and sun exposure have been shown to accelerate facial aging. There is evidence that changes to the midface and lower third of the face in isolation contribute significantly to one’s perception of overall facial age. With data suggesting that facial coverings are effective against the spread of the respiratory virus COVID-19, mask wearing has become commonplace. To date, there have been no studies that explore how covering the lower third of the face impacts an observer’s perception of age. OBJECTIVES: We hypothesize that covering the lower third of the face with a mask will make a person appear younger. METHODS: One hundred consecutive plastic surgery patients were photographed in a standardized fashion, both masked and unmasked. A questionnaire for factors known to contribute to facial aging was administered. These photographs were randomized to 6 judges who estimated the patients’ age and also quantified facial rhytids with the validated Lemperle wrinkle assessment score6. Data were analyzed using PROC MIXED analysis. RESULTS: Masked patients on average appeared 6.17% younger (mean difference = 3.16 years, 95% CI = 2.26-4.06, P < 0.0001). Wrinkle assessment scores were 9.81% lower in the masked group (mean difference = 0.21, 95% CI = 0.10-0.32, P = 0.0003). All subgroups appeared younger in a mask except for patients aged 18-40 years chronological age (P = 0.0617) and patients BMI>35 (P = 0.5084). CONCLUSIONS: The mask group appeared younger and had lower overall and visible wrinkle assessment scores when compared to the unmasked group. This has implications for our understanding of the contributions of the lower third of the face to overall perceived facial age.