Goals/Purpose:
Facial “rejuvenation” procedures make an implicit claim to provide a more youthful appearance. Numerous commercial products and operations have been promoted to “turn the clock back,” often by 10 years or more. However, the effectiveness of such products and procedures has never been rigorously evaluated. This study was undertaken to investigate the effectiveness of full facial rejuvenation using a sub-SMAS facelift and other cosmetic procedures performed simultaneously. The possible influence of age, gender, BMI, facial shape (oval, long, round, square and heart-shaped), and combination of procedures was analyzed. This is the first study ever undertaken with a view to objectively quantifying and validating the claims of any facial rejuvenative product or procedure to make people look younger.
Methods/Technique:
Patients
A total of 75 patients were included in the study - 71 consecutive patients who met the study criteria and 4 controls. The inclusion criteria were: (i) facelift, primary or secondary, alone or in combination with other procedures, (ii) patient consent for public viewing of photographs, (iii) at least 6 months' follow-up, (iv) no intervening cosmetic procedures, including fillers or botulinum toxin, and (v) no makeup or jewelry.
Full-page frontal patient photographs (figs. 1-3) were shown individually to 198 members of the public (“age guessers”) who attended a Women's Exposition (figs. 1-3). Two different books of photographs were used, book A (shown to 100 age guessers) and book B (shown to 98 age guessers), with each book alternating 71 pages of “before” and “after” photographs, so that the age guessers in each group viewed either a “before” or “after” photograph, but not both photographs of the same patient, plus 4 identical control photographs.
Surgery
All facelifts were performed using a sub-SMAS facelift, with release of retaining ligaments, vertical vector, and orbicularis redraping.1 In 67 patients (94%), a submental lipectomy was performed with liposuction, and a corset playsmaplasty.2 Fat injection was performed in 61 patients (86%). Laser resurfacing was performed using the erbium laser, Ultrapulse carbon dioxide laser, or a combination, in 57 patients (80%). Blepharoplasties – upper, lower, or both - were performed in 54 patients (76%). All forehead lifts (45 patients, 63%) were performed endoscopically with titanium microscrew or Lactosorb fasteners. Chin/jowl implants were used in 15 patients (21%).
Results/Complications:
The mean reduction in apparent age for all surgical patients was 6.0 years (range 0.8 – 14.2 years) (p < 0.01) versus no change for the control patients. The average reduction in apparent age after a facelift alone was 4.6 years. Laser resurfacing, on average, provided 2.5 years of age reduction (p < 0.05). Eyelid surgery provided 2 years of reduction in apparent age (p < 0.05). A 2-year reduction was found for forehead lifts (p < 0.05) and fat injection, although this finding was NS for fat injection. Smokers' apparent age reduction averaged 8.1 years, more than nonsmokers (p < 0.05). There was no significant difference in apparent age reduction when patients were compared by gender, age (by decade), BMI, or facial shape.
Conclusion:
This study for the first time submits facial “rejuvenation” surgery to the scrutiny of the scientific method, in consecutive patients meeting rigorous criteria among blinded objective observers. It provides the first objective evidence that cosmetic surgery (or any intervention, surgical or otherwise) is effective in providing a more youthful appearance. Facelift, laser resurfacing, blepharoplasty, and endoscopic forehead lift all significantly contribute to a reduction in apparent age.
Fig. 1. This 42- year-old patient is seen (left) before and (right) 6 months after a facelift, submental lipectomy, upper and lower blepharoplasties, facial fat injection (36 cc), full face CO2 laser resurfacing, and an endoscopic forehead lift. Her before photo, contained in Book A was judged 60.6 years of age, and her after photo in Book B was judged 46.9 years old (although before and after photos are shown here, side-by-side, the books showed only one image, not both). The apparent age reduction was 14.2 years.
Fig. 2. This 58-year-old woman is seen (left) before and (right) 6 months after a facelift, upper and lower blepharoplasties, submental lipectomy, fat injection (53 cc), endoscopic forehead lift, and full face CO2 laser resurfacing. Her preoperative assessment was 56.8 years and her postoperative assessment was 47.4 years. Her apparent age reduction was 9.9 years.
Fig. 3. This 45-year-old patient was photographed (left) before and (right) 8 months after a facelift, submental lipectomy, upper and lower blepharoplasties, facial fat injection (45 cc), and full face CO2 and erbium laser skin resurfacing, and a chin/jawline augmentation. Her before photo, in Book A was judged 44.5 years old. Her after photo in Book B was judged 38.4 years old. Her apparent age reduction was 6.8 years. References 1. Hamra, S.T. Composite rhytidectomy. Plast. Reconstr. Surg. 90: 1, 1992. 2. Feldman, J.J. Corset platymsaplasty.
Plast. Reconstr. Surg. 85: 333, 1990.
