What’s in a Face at 50?

HIS hair is grayer, and the creases around his mouth have deepened. The bags under his eyes make him look a bit weary. But his brow is mostly smooth, his chin firm, his neck taut.

If it’s true, as George Orwell said, that by 50 people have the faces they deserve, then President Obama — whose birthday is Thursday — has fared well. But what’s in the face at 50? As the tail end of the baby boom reaches that milestone and looks in the mirror, the collective sigh may well be, what happened?

Time, heredity, sunlight, illness, smoking, good fortune and bad — all leave their marks on the face. People make instant judgments about one another’s age, health, mood, personality and character based on facial features, and yet we often judge unconsciously, not fully aware of the cues we’re reading. There’s more — and sometimes less — to aging than jowls, wattles and crow’s-feet.

Across time and cultures, the idea that there are secrets to be deduced from a person’s features has been irresistible. Efforts to predict character and personality — even criminal tendencies — by analyzing people’s faces and the shape and size of their skulls date back centuries and have swung through cycles, being in vogue and being denounced as fakery. In China, face-reading was an ancient art that mapped out more than 100 distinct regions and linked them to certain traits, illnesses and even fate. Today, self-described face-reading experts turn up periodically on TV shows with flakily earnest pronouncements about public figures based on appearance. One told Tyra Banks that Mr. Obama’s big ears meant he would listen to the country and that the “radiance” from his eyes meant he was a visionary.

But the face actually can reveal more than we might want to admit. At times people seem to have an uncanny ability to size one another up at a glance. Last year, researchers from Tufts University published a study showing that students were surprisingly accurate at telling Democrats from Republicans just by looking at photographs of their faces. In the students’ judgments, Republicans were more likely to look “powerful” and Democrats “warm.”

Astute diagnosticians also glean information from people’s faces. “There are volumes one can say medically about the face,” said Dr. Abraham Verghese, the senior associate chairman for the theory and practice of medicine at Stanford University and a best-selling memoirist and novelist.

Dr. Verghese is an advocate for what many say is a lost art in test-driven modern medicine: the in-person physical exam, the doctor’s ability to detect signs of illness just by looking and listening. He ran through a list of facial changes that can be tip-offs to ill health, and that doctors can pick up at a glance: a sparseness or absence of the outer third of the eyebrows can signal thyroid failure; a moon-shaped face may mean a person is taking steroids; a “laugh line” deeper on one side of the face than the other may indicate a previous stroke or other facial paralysis; a very broad forehead and large nose may signal acromegaly, a dangerous condition caused by too much growth hormone.

“One sees in airports people who have their heads tilted back and seem to be looking down at the world with a suspicious expression,” Dr. Verghese said. “Their eyes look sleepy.” The diagnosis: a neuromuscular disorder, myasthenia gravis, that makes the eyelids droop. To compensate, people tilt their heads back and raise their eyebrows.

The ears can be a tip-off to gout, if they have bumps (called gouty tophi) that look like tiny stones under the skin. A common sign of aging, though not of illness, is the arcus senilis, a whitish or grayish ring that forms around the iris in many older people.

“I can see someone in a certain light and see that they’ve had cataract surgery,” Dr. Verghese said, explaining that the lens implanted during the surgery gives off a “metallic glint” at certain angles.

A youthful look is itself often a sign of good health, Dr. Verghese added, explaining that illness tends to make people look older. “When someone looks much older, they usually have a chronic disease that’s been there for some time,” he said.

And so to gauge health generally, doctors in training on hospital rounds note whether patients look older, younger or the same as their “stated age.”

Dr. Verghese said a peek behind the ears is usually enough to detect the scars of a face-lift.

Plastic surgeons view the face far more analytically than the rest of us, with a sometimes unnerving ability to pinpoint subtle changes wrought by time.

Dr. Julius W. Few, a plastic surgeon in Chicago, said there was a “holy trinity” of changes in the face that made a person look older. First, there are wrinkles, age spots and other superficial changes, often worsened by sun exposure and smoking. Then, there is what plastic surgeons call “loss of volume,” the shrinking of the fat layers in the cheeks, which can create a gaunt or deflated look and cause bags under the eyes to stick out more. Finally, there is plain old drooping.

“Darker skin tends to show aging changes less obviously,” Dr. Few said. “The biggest reason probably has to do with the skin being able to shield itself from the harmful effects of the sun.”

He and other doctors said darker skin also tended to be oilier and somewhat thicker than pale skin; this makes it more supple and less prone to wrinkles. Blacks and Asians have still another advantage, Dr. Few said: they start out with fuller cheeks than do whites, so the fat loss that comes with middle age is less noticeable, and the face remains younger looking. But the outer corners of the eyes tend to droop more with age in blacks than in whites, he said.

The loss of fat in the cheeks is part of a reshaping of the face over time, said Dr. Sherrell J. Aston, the chairman of plastic surgery at the Manhattan Eye, Ear and Throat Hospital and a professor at the New York University School of Medicine. Soft tissue slides down over the cheekbone, producing laugh lines and making the cheekbones look a little flatter. The jaw line seems to widen because of the jowls.

“So what’s happened is, if you think of the face as being an upside-down triangle, with the wide portion running cheekbone to cheekbone across the nose, that’s a youthful person, wider over the cheekbones, and narrow across the jaw line,” Dr. Aston said. “When we’re older, it goes in the other direction, wider over the jaw line, and flatter over cheekbones.”

In some people, the outer corners of the eyebrows begin to droop a bit. As a result, Dr. Aston said, “the person will look less alert, less awake almost, certainly less alert and vigorous.”

The vertical creases between the eyes (the ones commonly erased with Botox) also add to the impression of aging. Chronic stress, anger and unhappiness take their toll, too.

“If you’re frowning, rubbing your face, making a lot of expressions, I think you can see some long-lasting effects,” said Dr. Jeffrey M. Kenkel, professor of plastic surgery at the University of Texas Southwestern Medical Center at Dallas, and president of the American Society for Aesthetic Plastic Surgery. “Dynamic lines form perpendicular to the muscles of our face. If you’re expressive and do that a lot, you’re going to get creases in your skin.”

Some men seem to improve with age, as their boyishness fades and is replaced by lines and touches of gray that suggest wisdom and experience. President Obama, despite his acknowledged smoking, may be one of those men who has become better looking over time.

“When I look at our president,” Dr. Few said, “I see a combination of good genetics and the fact that there’s extra pigment in the skin that is protective. Contrast that with, now he has some gray in his hair, a sign that he is older, but his face doesn’t match what you see in his hair. It’s a contrast that you could say is even more attractive. His face tells you one thing and his hair tells you something else.”

Dr. Z. Paul Lorenc, a plastic surgeon in Manhattan, said that most people found a face attractive when it was proportioned in even thirds: from the top of the forehead to the eyebrow; from the brow to the base of the nose; and from the nose to the chin. “If a face fits those ratios, we think that’s a pleasing face,” Dr. Lorenc said.

Women’s looks are rarely said to improve with age. In any case, plastic surgeons say plenty of men would gladly trade their wise, lived-in faces for fresher ones.

“It’s pretty well known that Wall Street has a lot of very young men in very powerful places, and that many of the middle-aged Wall Street men want to look more youthful and more vigorous, because at 52 or 53 they are concerned about the 35-year-old who is gnawing at their heels,” Dr. Aston said. “We see people in every specialty, whether male or female, saying: ‘I’ve got a lot of young people behind me. I need to stay in the game. I have to look as young as I feel.’ ”

The mind-body mismatch can sting in other ways. A graying baby boomer told this story about himself. He was standing in a crowded subway car in Manhattan when a pretty young woman, seated nearby, caught his eye and smiled. He smiled back, pleased to think that maybe he still had the right stuff after all. Then she offered him her seat.

via nytimes.com

Posted via email from Brian's posterous