Quantitative Analysis of Facial Skin Characteristics in Chinese Adult Females: A Multimodal Ultrasound Study

With advancing age and cumulative exposure to adverse environmental and climatic factors, facial skin undergoes progressive dermal collagen degradation, redistribution of subcutaneous adipose tissue and a decline in elastic fiber integrity. Multimodal ultrasound (MUS), which integrates ultra-high-frequency ultrasound, superb microvascular imaging (SMI) and shear wave elastography (SWE), enables comprehensive, non-invasive assessment of cutaneous and subcutaneous anatomical structures, microvascular perfusion and tissue biomechanics. Understanding the morphological and biomechanical differences of these tissues is crucial for optimizing pre-operative assessments of aesthetic and surgical methods for facial rejuvenation in specific areas, which could ensure safe and effective cosmetic treatments. The purpose of this study was to explore the feasibility and reliability of evaluating facial skin using MUS, to compare the differences in MUS parameters across various anatomical regions, measuring sections and right/left sides in healthy Chinese adult females, to analyze factors influencing MUS parameters and to investigate the correlation between MUS measurements and clinical assessments.

A total of 106 healthy female volunteers were enrolled in this study. Routine ultrasound, SMI and SWE examinations were performed at five designated facial skin sites-forehead, glabella, canthus, infraorbital area and oral commissure-with assessments of skin thickness, elasticity and blood flow acquired in both transverse and longitudinal planes. In addition, each participant underwent facial laxity scoring and VISIA (visual image skin analysis) examination. Differences in MUS measurements were evaluated across different age groups, body mass index (BMI) categories, sun protection habits, sectional planes, anatomical sites and laterality (left vs. right). Potential factors influencing MUS parameters of facial skin were analyzed. The relationships between cutaneous blood flow parameters and VISIA findings, as well as the correlation between MUS measurements and subjective clinical grading scores, were systematically evaluated.

No significant differences in MUS parameters were observed between the left and right sides (p > 0.05). There was statistically significant difference in skin elasticity measurements that differed significantly between transverse and longitudinal planes at the forehead, glabella and infraorbital region (p < 0.005), whereas no significant plane-dependent differences were found for skin thickness or SMI-derived blood flow grades (p > 0.05). Significant inter-site variations in skin thickness and elasticity were evident across the five anatomical locations (p < 0.05), whereas SMI blood flow grades showed a significant difference only between the glabella and infraorbital regions (p < 0.01). Advancing age and the absence of sun protection were associated with reduced skin thickness, diminished elasticity and elevated blood flow grades (p < 0.05). BMI exerted a significant effect on skin thickness at the forehead, glabella and angulus oris (p < 0.05). A significant negative correlation was identified between MUS parameters of facial skin and clinical laxity scores (p < 0.05), indicating that higher laxity scores corresponded to decreased skin thickness and elasticity. Furthermore, SMI blood flow grades showed a significant negative correlation with VISIA (red area percentiles) (p < 0.05).

MUS enables quantitative evaluation of facial skin condition. Region-specific variations in MUS parameters were identified, with age and sun protection habits emerging as principal contributing factors. Notably, ultrasound measurements demonstrated significant correlations with both clinical scores of facial laxity scores and VISIA red area assessments. The findings of this study provide a methodological foundation for the establishment of normative facial skin imaging databases in healthy populations and offer a robust reference framework for the evaluation of pathological cutaneous alterations.