The official birthday (200th) of Abraham Lincoln, our 16th president from1861 to 1865, occurred on February 12, 2009. Many states that had formerly observed Lincoln’s birthday have created a joint holiday to honor both Lincoln and our first president George Washington, known as Presidents Day. It coincides with the Federal holiday officially designated Washington’s Birthday, observed on the third Monday of February.
Abraham Lincoln had a very distinct face and it epitomizes the ‘gaunt look’. Based on photogtraphs, he had such a facial appearance since he was a young man but it became more pronounced as he got older. A story is told that at the age of 51, an eleven-year old child told him to grow a beard to make his face look fuller. He remained with a beard until his untimely death. Even with a beard, Lincoln’s face showed his sunken cheeks and a classic facial lipoatrophy appearance. Even a cursory look at his face on Mt. Rushmore shows how different his face appeared from the other presidents.
Facial lipoatrophy, sometimes referred to as facial wasting, is the loss of fat in the face usually in the cheek and temple areas. It is not necessarily loss of fat in all cases, in some it is simply that these fat areas never developed to any degree. It really represents a failure of adequate development of the buccal fat pad and all its extensions or a loss of this fat pad over time due to aging or certain medications. Facial lipoatrophy presents itself in five degrees of severity from the subtle type I, which usually represents as a mild congenital or natural gauntness to the face to the most severe type 5 which is best illustrated in the HIV patient where total loss of the buccal fat pad occurs due to the antiviral medications.
While a mild type 1 facial lipoatrophy appearance can be quite attractive when one is young (due to the appearance of high cheekbones), ongoing aging in one’s later years creates more of an unhealthy aged appearance. President Lincoln had by the time of his presidency a type III or IV facial lipoatrophy condition. He had a very skeletonized face with completely sunken in submalar (below the cheekbones) areas that even his beard could not mask. His facial lipoatrophy condition was congenital or developmental in nature.
In severe facial lipoastrophy cases of the HIV patient, treatment of this facial appearance helps mask the stigmata of the disease. Various treatment options exist for the treatment of facial lipoatrophy and they can be tailored to how sunken the face appears. Most of the treatment approaches focus on the cheek or midface areas for enhancement by volume addition of fat through either fat injections or even dermal-fat grafts.
Dr. Barry Eppley
Indianapolis, Indiana