The Esthetics of the Nasolabial Fold and Age in the Elderly Via Eye-Tracking.

Background: Facial aging is associated with the loss of soft tissue fullness. Perioral signs of facial aging can add years to individuals' appearances and even affect their facial expressions in smiling and nonsmiling images.

Aims: To evaluate the influence of the nasolabial fold on the visual perception of esthetics and age in the elderly, eye-tracking and a visual analog scale were used.

Material and methods: This study applied a cross-sectional study using 40 laypeople. Facial images of an elderly woman were modified to include facial expression lines such as nasolabial folds and marionette lines with no folds, intermediate, and accentuated depths folds. Eye tracking was implemented to measure the average number of fixations. Heat maps and dot maps were generated using eye-tracking software. A visual analog scale of attractiveness and age perception questionnaire were also incorporated into the study. Statistical analysis was performed using a significance of (P<0.05).

Results: The majority of visual attention was paid to the eye and mouth areas. In the images with no folds, the right eye attracted a greater degree of fixation. In the images in which nasolabial folds were accentuated, the mouth area served as an area of high fixation. No statistical difference was observed between the groups in which smiling images were viewed. Nonsmiling images demonstrated significant differences between groups for variables including time until first fixation, complete fixation time, and number of fixations on the eyes and hemifaces. Old age and diminished attractiveness were associated with attenuated nasolabial folds, especially in nonsmiling images.

Conclusion: The facial lines and expressions of elderly female individuals were assessed by laypeople using eye-tracking, showing that the deeper one's nasolabial folds, the more aged and less attractive one appears, especially in nonsmiling images. Smiling pictures were perceived to be more attractive and youthful; these perceptions should be considered in the search for improved esthetic results, whether in dental or facial esthetic treatments.