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JAMA Dermatology
JAMA Dermatol. 2018 Mar; 154(3): 365–367.
Published online 2018 Jan 3. doi:10.1001/jamadermatol.2017.5142
Murad Alam, MD, MSCI, MBA,
1,2,3 Anne J. Walter, MD, MBA,1,7 Amelia Geisler, BS,1 Wanjarus Roongpisuthipong, MD,1,4 Gary Sikorski,5 Rebecca Tung, MD,6 and Emily Poon, PhD1
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This pilot study assesses the association of a 20-week facial exercise program with the facial appearance of middle-aged women.
Physical manifestations of facial aging are now understood to include not only skin laxity and superficial photodamage but also deeper substructural volume loss of fat and muscle.
There has been recent interest in the lay community in facial exercises or facial “yoga” that can rejuvenate the aging face, presumably by inducing underlying muscle growth. In this report, we describe what we believe to be the first clinical trial to assess facial exercise as a modality for improving skin appearance.
Methods
Healthy participants aged 40 to 65 years with photodamage, associated mild to moderate facial atrophy, and with an interest in facial exercises were included. Participants received formal instruction on 32 facial exercises. All participants attended 2 live 90-minute muscle-resistant facial exercise training sessions with a certified facial exercise instructor (G.S.). Neither participants nor those administering the interventions were blinded. After the initial training sessions with the instructor, participants performed daily 30-minute exercises for 8 weeks at home. During weeks 9 to 20, participants continued practicing exercises every other day (3-4 times per week).
This study was approved by the Northwestern University Institutional Review Board and registered at ClinicalTrials.gov (NCT01689012) prior to participant enrollment. Written informed consent was obtained from all participants. Recruitment and enrollment took place from January to February 2013. Study procedures were from March to July 2013, and data analyses were performed from April to May 2015.
The primary objective was to determine the association of a facial muscle exercise program with the appearance of the face and neck. The secondary objective was to measure participant satisfaction with facial appearance before and after completion of the exercise program.
The primary outcome measure was assessment of standard photographs rated by 2 blinded physicians (M.A., W.R.) using the validated Merz-Carruthers Facial Aging Photoscales (MCFAP). The co-primary outcome measure was blinded rater estimation of participant age. A secondary outcome measure was participant satisfaction questionnaire on an 11-point visual analogue scale (0 = not satisfied at all, 10 = extremely satisfied).
Scores on the MCFAP were analyzed using the Wilcoxon signed-rank test as the nonparametric alternative to paired t tests. Data for predicted age and participant satisfaction were analyzed with 2-sided paired t tests. Significance level was set at .05.
Results
Twenty-seven participants were enrolled (33 screened, 33 found to be eligible, 6 declined to enroll). Sixteen received the full 20-week intervention (11 dropped out) and all follow-up visits, and the data from these were analyzed. Demographic and clinical characteristics of participants are displayed in Table 1. Results of the MCFAP are reported in Table 2.
Table 1.
Demographic Characteristics of 16 Patients
| Characteristic | Valuea |
|---|---|
| Age, mean (SD), y | 53.7 (5.8) |
| Female sex, No. (%) | 16 (100) |
| Race, No. (%) | |
| Asian | 1 (6) |
| Black | 2 (12) |
| White | 11 (69) |
| Other | 2 (12) |
| Ethnicity, No. (%) | |
| Hispanic or Latino | 2 (12) |
| Not Hispanic or Latino | 11 (69) |
| Unknown | 3 (19) |
| Skin type, No. (%) | |
| II | 6 (38) |
| III | 4 (25) |
| IV | 4 (25) |
| V | 2 (12) |
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aPercentages may not total 100 because of rounding.
Table 2.
Merz-Carruthers Facial Aging Photoscalesa
| Validated Assessment Scale | Mean (SD) | P Valueb | ||
|---|---|---|---|---|
| Baseline | Week 8 | Week 20 | ||
| Upper face | ||||
| Forehead lines at rest | 0.6 (0.5) | 0.7 (0.6) | 0.8 (0.7) | .38 |
| Forehead lines dynamic | 1.7 (1.3) | 2.2 (1.0) | 2.2 (1.1) | .20 |
| Glabellar lines at rest | 0.9 (0.7) | 0.8 (0.6) | 0.8 (0.7) | .50 |
| Glabellar lines dynamic | 1.9 (1.3) | 1.6 (1.3) | 1.9 (1.4) | >.99 |
| Crow’s feet at rest | 1.1 (0.9) | 1.1 (0.9) | 1.2 (0.8) | >.99 |
| Crow’s feet dynamic | 2.4 (1.1) | 2.3 (1.1) | 2.5 (1.2) | .78 |
| Female brow at rest | 1.9 (1.1) | 1.9 (0.9) | 1.9 (0.8) | >.99 |
| Mid-face | ||||
| Infraorbital hollow | 1.3 (0.8) | 1.4 (0.6) | 1.7 (0.7) | .11 |
| Upper cheek fullness | 1.8 (0.7) | 1.9 (0.9) | 1.1 (0.6) | .003 |
| Lower cheek fullness | 1.6 (0.9) | 1.3 (0.7) | 0.9 (0.7) | .003 |
| Lower face | ||||
| Nasolabial folds at rest | 1.1 (0.8) | 1.6 (0.8) | 1.1 (0.8) | >.99 |
| Marionette lines at rest | 1.4 (0.8) | 1.6 (0.6) | 1.2 (0.8) | .22 |
| Upper lip fullness at rest | 2.9 (1.0) | 2.9 (0.9) | 3.2 (0.8) | .29 |
| Lower lip fullness at rest | 1.8 (0.8) | 2.3 (0.7) | 2.3 (0.9) | .11 |
| Lip wrinkles at rest | 0.9 (0.8) | 0.8 (0.8) | 0.8 (0.5) | .62 |
| Lip wrinkles dynamic | 1.4 (1.0) | 1.5 (1.2) | 1.9 (1.0) | .056 |
| Oral commissures at rest | 1.2 (0.8) | 0.9 (0.8) | 1.1 (0.7) | .69 |
| Jawline at rest | 1.8 (1.2) | 1.4 (1.2) | 1.4 (1.1) | .31 |
| Neck | ||||
| Neck volume scale | 1.9 (1.1) | 1.6 (1.0) | 1.4 (0.8) | .11 |
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aFive-point scale (0-4) with 0 being the best outcome and 4 being the worst outcome.
bWilcoxon signed-rank test performed comparing baseline (preexercise) with week 20 (postexercise) scores only.
Based on the MCFAP scales (Table 2), facial exercise resulted in improved mean (SD) upper cheek fullness (1.1 [0.6] vs 1.8 [0.7]; P = .003) and lower cheek fullness (0.9 [0.7] vs 1.6 [0.9]; P = .003) at 20 weeks vs baseline. Mean (SD) estimated age decreased significantly when baseline was compared with study end (50.8 [4.8] y vs 48.1 [5.5] y; P = .002). Participants were more satisfied with all facial aging outcomes when baseline was compared with end of study (data not shown).
Discussion
A 30-minute daily or alternate-day facial exercise program sustained over 20 weeks may modestly improve the facial appearance of selected middle-aged women. Blinded ratings of validated photoscales showed significant improvement in upper and lower cheek fullness. Rater estimates of mean participant age showed a significant monotonic decrease from 50.8 years at baseline to 49.6 years at 8 weeks and 48.1 years at 20 weeks. Participants were highly satisfied, noting significant improvement in 18 of 20 facial features.
This study had limitations that may reduce its external validity. The sample was small, exclusively of middle-aged women, there were numerous dropouts, and there was no control group in the study. Another limitation is that participants were self-selected and may have been particularly willing to continue with an exercise regimen.
In conclusion, a regimen of at-home facial exercises maintained for 20 weeks seemed to improve mid-face and lower face fullness. The mechanism may be exercise-actuated hypertrophy of cheek and other muscles. Further research is warranted to isolate the causes and effects of exercise-related changes and to assess the generalizability of these findings.
References
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Articles from JAMA Dermatology are provided here courtesy of American Medical Association
