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Evolving features of the patient at age 3 months (A), 1 year (B), 3 years (C), 5 years (D), 8 years (E), 11 years (F), 13 years (G), 15 years (H), 18 years (I), and 20 years (J). Note the progressive coarsening of facial features, sparse hair (A, B), eversion and filling of lower vermilion (F–J), and prognathism (I, J). Triangular face, downslanting palpebral fissures, malar hypoplasia, and thick alae nasi are seen throughout.
