OBJECTIVES: Facial directional asymmetry research, including age-related changes, is crucial for the evaluation of treatment of craniofacial malformations/trauma in orthodontics, facial surgery and forensic sciences. The aim was to describe facial directional asymmetry (DA) in different age categories of adults using 3D methods. According to our hypothesis, facial shape DA (1) depends on sex; (2) differs among age groups; and (3) has wider variability in older age. MATERIAL AND METHODS: A cross-sectional sample of healthy Czech adults without craniofacial trauma or anomalies consisted of 300 3D facial models (151 females). The age-range in the study was between 20-80 years. The shape asymmetry of 28 3D landmarks was evaluated using geometric morphometrics and multivariate statistics. RESULTS: The manifestation of DA was similar in both sexes and in each age category; however, there were some statistical differences. In contrast to the ideal symmetrical face, the mean asymmetrical faces tended to create a slightly bent "C" shape of the midline. Therefore, the upper face was rotated slightly clockwise and the lower face counter-clockwise. The right eye was located slightly higher, with the nasal tip and mandibular region tilting to the left. Sex differences in facial DA were significant before the age of 40. DA was more significant in the youngest males than in the oldest, while the women's DA did not change. CONCLUSIONS: The DA patterns were similar in both sexes and in all age categories (a slightly bent C shape of the midline); however, some significant local differences between male age groups were found. A significantly more pronounced asymmetry compared to other age groups was found only in the youngest males from 20 to 40 years. Moreover, significant sexual dimorphism of DA rapidly decreased after middle age, likely caused by the same age-related changes of the face during aging.

Department of Histology and Embryology 3rd Faculty of Medicine Charles University Prague Czech Republic

Laboratory of 3D Imaging and Analytical Methods Department of Anthropology and Human Genetics Faculty of Science Charles University Prague Czech Republic

Erratum v

PLoS One. 2024 Jun 5;19(6):e0305196. doi: 10.1371/journal.pone.0305196. PubMed

Zobrazit více v PubMed

Linden OE, He JK, Morrison CS, Sullivan SR, Taylor HOB. The Relationship between Age and Facial Asymmetry: Plastic and Reconstructive Surgery [Internet]. November 2018. [cited 6. March 2022];142(5):1145–52. Available: http://journals.lww.com/00006534-201811000-00008 PubMed

Beer K, Beer J. Overview of Facial Aging. Facial plast Surg [Internet]. December 2009. [cited 5. March 2022];25(05):281–4. Available: http://www.thieme-connect.de/DOI/DOI? doi: 10.1055/s-0029-1243075 PubMed DOI

Kaur M, Garg RK, Singla S. Analysis of facial soft tissue changes with aging and their effects on facial morphology: A forensic perspective. Egyptian Journal of Forensic Sciences [Internet]. Jun 2015. [cited 25. February 2022];5(2):46–56. Available: http://linkinghub.elsevier.com/retrieve/pii/S2090536X14000501

Haraguchi S, Iguchi Y, Takada K. Asymmetry of the Face in Orthodontic Patients. The Angle Orthodontist [Internet]. 1. May 2008. [cited 7. Jun 2022];78(3):421–6. Available: https://meridian.allenpress.com/angle-orthodontist/article/78/3/421/58647/Asymmetry-of-the-Face-in-Orthodontic-Patients doi: 10.2319/022107-85.1 PubMed DOI

Měšťák J. Estetické operace nosu v klinické praxi. 1. Praha: Grada Publishing, a.s.; 2020. 208 s.

Wang TT, Wessels L, Hussain G, Merten S. Discriminative Thresholds in Facial Asymmetry: A Review of the Literature. Aesthetic Surgery Journal [Internet]. 1. April 2017. [cited 20. February 2023];37(4):375–85. Available: https://academic.oup.com/asj/article/37/4/375/2993791 doi: 10.1093/asj/sjw271 PubMed DOI

Pazdera J. Základy ústní a čelistní chirurgie. Olomouc; 2013.

Severt T, Proffit W. The prevalence of facial asymmetry in the dentofacial deformities population at the University of North Carolina. Int J Adult Orthodon Orthognath Surg. 1997;12(3). PubMed

Beltran J, Zaror C, Moya MP, Netto HD, Olate S. Diagnosis and Treatment in Unilateral Condylar Hyperplasia. JCM [Internet]. 28. January 2023. [cited 13. February 2023];12(3):1017. Available: https://www.mdpi.com/2077-0383/12/3/1017 doi: 10.3390/jcm12031017 PubMed DOI PMC

Cassi D, Battistoni G, Magnifico M, Di Blasio C, Pedrazzi G, Di Blasio A. Three-dimensional evaluation of facial asymmetry in patients with hemifacial microsomia using stereophotogrammetry. Journal of Cranio-Maxillofacial Surgery [Internet]. January 2019. [cited 6. April 2020];47(1):179–84. Available: https://linkinghub.elsevier.com/retrieve/pii/S1010518218306322 doi: 10.1016/j.jcms.2018.11.011 PubMed DOI

Golshah A, Hajiazizi R, Azizi B, Nikkerdar N. Assessment of the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate. Contemp Clin Dent [Internet]. 2022. [cited 13. February 2023];13(1):40. Available: https://journals.lww.com/10.4103/ccd.ccd_652_20 PubMed DOI PMC

Azuma T, Fuchigami T, Nakamura K, Kondo E, Sato G, Kitamura Y, et al.. New method to evaluate sequelae of static facial asymmetry in patients with facial palsy using three-dimensional scanning analysis. Auris Nasus Larynx [Internet]. October 2022. [cited 13. February 2023];49(5):755–61. Available: https://linkinghub.elsevier.com/retrieve/pii/S0385814622000256 doi: 10.1016/j.anl.2022.01.007 PubMed DOI

Rohrich RJ, Villanueva NL, Small KH, Pezeshk RA. Implications of Facial Asymmetry in Rhinoplasty. Plastic & Reconstructive Surgery [Internet]. September 2017. [cited 27. February 2023];140(3):510–6. Available: https://journals.lww.com/00006534-201709000-00018 doi: 10.1097/PRS.0000000000003606 PubMed DOI

Kau C, Zhurov A, Richmond S, Cronin A, Savio C, Mallorie C. Facial templates: a new perspective in three dimensions. Orthod Craniofac Res [Internet]. February 2006. [cited 27. February 2023];9(1):10–7. Available: https://onlinelibrary.wiley.com/doi/10.1111/j.1601-6343.2006.00359.x PubMed DOI

Lee M song, Chung DH, Lee J woo, Cha K suk. Assessing soft-tissue characteristics of facial asymmetry with photographs. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. July 2010. [cited 27. February 2023];138(1):23–31. Available: https://linkinghub.elsevier.com/retrieve/pii/S0889540610001940 doi: 10.1016/j.ajodo.2008.08.029 PubMed DOI

Moslerová V, Dadáková M, Dupej J, Hoffmannova E, Borský J, Černý M, et al.. Three-dimensional assessment of facial asymmetry in preschool patients with orofacial clefts after neonatal cheiloplasty. International Journal of Pediatric Otorhinolaryngology [Internet]. May 2018. [cited 27. February 2023];108:40–5. Available: https://linkinghub.elsevier.com/retrieve/pii/S0165587618300892 doi: 10.1016/j.ijporl.2018.02.023 PubMed DOI

Zimbler MS, Kokoska MS, Thomas JR. Anatomy and pathophysiology of facial aging. Facial Plast Surg Clin North Am. May 2001;9(2):179–87, vii. PubMed

Sajid M, Taj IA, Bajwa UI, Ratyal NI. The role of facial asymmetry in recognizing age-separated face images. Computers & Electrical Engineering [Internet]. August 2016. [cited 17. February 2022];54:255–70. Available: https://linkinghub.elsevier.com/retrieve/pii/S0045790616000033

Harastani M, Benterkia A, Zadeh FM, Nait-Ali A. Methamphetamine drug abuse and addiction: Effects on face asymmetry. Computers in Biology and Medicine [Internet]. January 2020. [cited 17. February 2022];116:103475. Available: https://linkinghub.elsevier.com/retrieve/pii/S0010482519303452 doi: 10.1016/j.compbiomed.2019.103475 PubMed DOI

Cheong YW, Lo LJ. Facial asymmetry: etiology, evaluation, and management. Chang Gung Med J. August 2011;34(4):341–51. PubMed

Claes P, Walters M, Shriver MD, Puts D, Gibson G, Clement J, et al.. Sexual dimorphism in multiple aspects of 3D facial symmetry and asymmetry defined by spatially dense geometric morphometrics: Spatially dense sexual dimorphism in 3D facial shape. Journal of Anatomy [Internet]. august 2012. [cited 24. July 2020];221(2):97–114. Available: http://doi.wiley.com/10.1111/j.1469-7580.2012.01528.x PubMed DOI PMC

Alford R, Alford KF. Sex differences in asymmetry in the facial expression of emotion. Neuropsychologia [Internet]. January 1981. [cited 20. March 2022];19(4):605–8. Available: https://linkinghub.elsevier.com/retrieve/pii/0028393281900294 doi: 10.1016/0028-3932(81)90029-4 PubMed DOI

Ferrario VF, Sforza C, Ciusa V, Dellavia C, Tartaglia GM. The effect of sex and age on facial asymmetry in healthy subjects: A cross-sectional study from adolescence to mid-adulthood. Journal of Oral and Maxillofacial Surgery [Internet]. April 2001. [cited 6. March 2022];59(4):382–8. Available: https://linkinghub.elsevier.com/retrieve/pii/S0278239101710294 doi: 10.1053/joms.2001.21872 PubMed DOI

Albert AM, Ricanek K, Patterson E. A review of the literature on the aging adult skull and face: Implications for forensic science research and applications. Forensic Science International [Internet]. October 2007. [cited 21. April 2020];172(1):1–9. Available: https://linkinghub.elsevier.com/retrieve/pii/S0379073807001624 doi: 10.1016/j.forsciint.2007.03.015 PubMed DOI

Velemínská J, Fleischmannová N, Suchá B, Dupej J, Bejdová Š, Kotěrová A, et al.. Age-related differences in cranial sexual dimorphism in contemporary Europe. Int J Legal Med [Internet]. September 2021. [cited 7. May 2022];135(5):2033–44. Available: https://link.springer.com/10.1007/s00414-021-02547-6 PubMed DOI

Wysong A, Joseph T, Kim D, Tang JY, Gladstone HB. Quantifying Soft Tissue Loss in Facial Aging: A Study in Women Using Magnetic Resonance Imaging. Dermatologic Surgery [Internet]. December 2013. [cited 5. March 2022];39(12):1895–902. Available: https://journals.lww.com/00042728-201312000-00016 doi: 10.1111/dsu.12362 PubMed DOI

Nanda RS, Meng H, Kapila S, Goorhuis J. Growth changes in the soft tissue facial profile. Angle Orthodontist. 1990;60(3):177–90. doi: 10.1043/0003-3219(1990)060<0177:GCITST>2.0.CO;2 PubMed DOI

See MS, Roberts C, Nduka C. Age- and Gravity-Related Changes in Facial Morphology: 3-Dimensional Analysis of Facial Morphology in Mother-Daughter Pairs. Journal of Oral and Maxillofacial Surgery [Internet]. July 2008. [cited 7. March 2022];66(7):1410–6. Available: https://linkinghub.elsevier.com/retrieve/pii/S0278239108000906 doi: 10.1016/j.joms.2007.12.041 PubMed DOI

Economou S, Stoustrup P, Kristensen KD, Dalstra M, Küseler A, Herlin T, et al.. Evaluation of facial asymmetry in patients with juvenile idiopathic arthritis: Correlation between hard tissue and soft tissue landmarks. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. May 2018. [cited 6. April 2020];153(5):662–672.e1. Available: https://linkinghub.elsevier.com/retrieve/pii/S0889540618300556 doi: 10.1016/j.ajodo.2017.08.022 PubMed DOI

Ferrario VF, Sforza C, Miani A, Tartaglia G. Craniofacial morphometry by photographic evaluations. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. April 1993. [cited 21. May 2020];103(4):327–37. Available: https://linkinghub.elsevier.com/retrieve/pii/088954069370013E doi: 10.1016/0889-5406(93)70013-E PubMed DOI

Ferrario VF, Sforza C, Miani A, Serrao G. A three-dimensional evaluation of human facial asymmetry. J Anat. February 1995;186 (Pt 1):103–10. PubMed PMC

Hafezi F, Javdani A, Naghibzadeh B, Ashtiani AK. Laterality and Left-sidedness in the Nose, Face, and Body: A New Finding. Plastic and Reconstructive Surgery—Global Open [Internet]. December 2017. [cited 20. April 2020];5(12):e1590. Available: http://Insights.ovid.com/crossref?an=01720096-201712000-00003 PubMed PMC

Lindell A. Lateralization of the expression of facial emotion in humans. In: Progress in Brain Research [Internet]. Elsevier; 2018. [cited 20. April 2020]. s. 249–70. Available: https://linkinghub.elsevier.com/retrieve/pii/S0079612318300505 PubMed

Hausmann M, Behrendt-Körbitz S, Kautz H, Lamm C, Radelt F, Güntürkün O. Sex differences in oral asymmetries during wordrepetition. Neuropsychologia [Internet]. December 1998. [cited 21. April 2020];36(12):1397–402. Available: https://linkinghub.elsevier.com/retrieve/pii/S002839329800027X doi: 10.1016/s0028-3932(98)00027-x PubMed DOI

Mardia KV, Bookstein FL, Moreton IJ. Statistical assessment of bilateral symmetry of shapes. Biometrika Trust [Internet]. 2000;(87):285–300. Available: https://about.jstor.org/terms

Klingenberg CP, Barluenga M, Meyer A. SHAPE ANALYSIS OF SYMMETRIC STRUCTURES: QUANTIFYING VARIATION AMONG INDIVIDUALS AND ASYMMETRY. Evolution [Internet]. October 2002. [cited 7. February 2019];56(10):1909–20. Available: http://doi.wiley.com/10.1111/j.0014-3820.2002.tb00117.x PubMed DOI

Klingenberg C. Analyzing Fluctuating Asymmetry with Geometric Morphometrics: Concepts, Methods, and Applications. Symmetry [Internet]. 2. Jun 2015. [cited 11. September 2019];7(2):843–934. Available: http://www.mdpi.com/2073-8994/7/2/843

Executive Summary of the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Arch Intern Med [Internet]. 28. September 1998. [cited 13. February 2023];158(17):1855. Available: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.158.17.1855 PubMed

Velemínská J, Bigoni L, Krajíček V, Borský J, Šmahelová D, Cagáňová V, et al.. Surface facial modelling and allometry in relation to sexual dimorphism. HOMO [Internet]. April 2012. [cited 20. March 2022];63(2):81–93. Available: https://linkinghub.elsevier.com/retrieve/pii/S0018442X12000182 doi: 10.1016/j.jchb.2012.02.002 PubMed DOI

von Cramon-Taubadel N, Frazier BC, Lahr MM. The problem of assessing landmark error in geometric morphometrics: Theory, methods, and modifications. Am J Phys Anthropol [Internet]. September 2007. [cited 13. February 2023];134(1):24–35. Available: https://onlinelibrary.wiley.com/doi/10.1002/ajpa.20616 PubMed DOI

Klingenberg CP. MorphoJ: an integrated software package for geometric morphometrics [Internet]. 2011. Available: doi: 10.1111/j.1755-0998.2010.02924.x PubMed DOI

R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2018. Available: https://www.R-project.org/

GOM Precise Industrial 3D Metrology. GOM Inspect [Internet]. 2019. Available: https://www.gom.com/3d-software/gom-inspect.htm

Bonferroni CE. Teoria statistica delle classi e calcolo delle probabilit `a. Pubblicazioni del R Istituto Superiore di Scienze Economiche e Commerciali di Firenze. 1936;(3):3–62.

Zama M, Rizzo MI. Craniofacial Malformations. In: Maruccia M, Giudice G, editors. Textbook of Plastic and Reconstructive Surgery [Internet]. Cham: Springer International Publishing; 2022. [cited 14. Jun 2022]. s. 167–200. Available: https://link.springer.com/10.1007/978-3-030-82335-1_12 DOI

Franklin DrS Ruotolo DrR, Schultz DrK Fantasia DrJ. Heterozygous Mutations in ANTXR2 Gene in a Child with Oral Manifestations of Hyaline Fibromatosis Syndrome: A Case Report and Review of Phenotype-Genotype Correlations. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology [Internet]. May 2022. [cited 14. Jun 2022];133(5):e133–4. Available: https://linkinghub.elsevier.com/retrieve/pii/S2212440321008026

Vyas K, Gibreel W, Mardini S. Virtual Surgical Planning (VSP) in Craniomaxillofacial Reconstruction. Facial Plastic Surgery Clinics of North America [Internet]. May 2022. [cited 14. Jun 2022];30(2):239–53. Available: https://linkinghub.elsevier.com/retrieve/pii/S1064740622000165 doi: 10.1016/j.fsc.2022.01.016 PubMed DOI

Cohen MM. Perspectives on craniofacial asymmetry. International Journal of Oral and Maxillofacial Surgery [Internet]. February 1995. [cited 21. May 2020];24(1):2–7. Available: https://linkinghub.elsevier.com/retrieve/pii/S0901502705808483 PubMed

Tiwari S, Nambiar S, Unnikrishnan B. Chewing side preference—Impact on facial symmetry, dentition and temporomandibular joint and its correlation with handedness. Journal of Orofacial Sciences [Internet]. 2017. [cited 14. April 2020];9(1):22. Available: http://www.jofs.in/text.asp?2017/9/1/22/207940

Hodgetts S, Hausmann M. Antipsychotic effects of sex hormones and atypical hemispheric asymmetries. Cortex [Internet]. Jun 2020. [cited 20. April 2020];127:313–32. Available: https://linkinghub.elsevier.com/retrieve/pii/S0010945220300800 doi: 10.1016/j.cortex.2020.02.016 PubMed DOI

Bigoni L, Krajíček V, Sládek V, Velemínský P, Velemínská J. Skull shape asymmetry and the socioeconomic structure of an early medieval central european society. American Journal of Physical Anthropology [Internet]. March 2013. [cited 30. March 2020];150(3):349–64. Available: http://doi.wiley.com/10.1002/ajpa.22210 PubMed DOI

Ibrová A, Dupej J, Stránská P, Velemínský P, Poláček L, Velemínská J. Facial skeleton asymmetry and its relationship to mastication in the Early Medieval period (Great Moravian Empire, Mikulčice, 9th–10th century). Archives of Oral Biology [Internet]. December 2017. [cited 24. May 2022];84:64–73. Available: https://linkinghub.elsevier.com/retrieve/pii/S0003996917302868 PubMed

Yang HJ, Hwang SJ. Evaluation of postoperative stability after BSSRO to correct facial asymmetry depending on the amount of bone contact between the proximal and distal segment. Journal of Cranio-Maxillofacial Surgery [Internet]. July 2014. [cited 20. March 2022];42(5):e165–70. Available: https://linkinghub.elsevier.com/retrieve/pii/S1010518213002138 doi: 10.1016/j.jcms.2013.07.015 PubMed DOI

Quinto-Sánchez M, Adhikari K, Acuña-Alonzo V, Cintas C, Silva de Cerqueira CC, Ramallo V, et al.. Facial asymmetry and genetic ancestry in Latin American admixed populations: FACIAL ASYMMETRY IN LATIN AMERICANS. American Journal of Physical Anthropology [Internet]. May 2015. [cited 27. July 2020];157(1):58–70. Available: http://doi.wiley.com/10.1002/ajpa.22688 PubMed DOI

Babczyńska A, Kawala B, Sarul M. Genetic Factors That Affect Asymmetric Mandibular Growth—A Systematic Review. Symmetry [Internet]. 28. February 2022. [cited 18. February 2023];14(3):490. Available: https://www.mdpi.com/2073-8994/14/3/490

Windhager S, Schaschl H, Schaefer K, Mitteroecker P, Huber S, Wallner B, et al.. Variation at Genes Influencing Facial Morphology Are Not Associated with Developmental Imprecision in Human Faces. O’Rourke D, editor. PLoS ONE [Internet]. 10. Jun 2014. [cited 18. February 2023];9(6):e99009. Available: https://dx.plos.org/10.1371/journal.pone.0099009 PubMed DOI PMC

Samal A, Subramani V, Marx D. Analysis of sexual dimorphism in human face. Journal of Visual Communication and Image Representation [Internet]. December 2007. [cited 20. April 2022];18(6):453–63. Available: https://linkinghub.elsevier.com/retrieve/pii/S1047320307000405

Roosenboom J, Indencleef K, Lee MK, Hoskens H, White JD, Liu D, et al.. SNPs Associated With Testosterone Levels Influence Human Facial Morphology. Front Genet [Internet]. 23. October 2018. [cited 20. April 2022];9:497. Available: https://www.frontiersin.org/article/10.3389/fgene.2018.00497/full PubMed DOI PMC

The relationship between facial directional asymmetry, handedness, chewing side preference, and eyedness