To assess the durability of facelift surgery using objective and validated subjective measurements.
Methods/Technique:
Since 2001 the senior surgeon (BMJ) has used a standardized system of clinical photography. From 2001 to 2011 he carried out 1745 facelifts. Of these 50 primary facelift patients returned for long term assessment at an average of 5.5 years post surgery. The longevity of a primary facelift was assessed using three types of outcome measures.
- Objective measurements: Using computer softwear (Bray et al 2010) which takes the iris as a constant marker for facial measurements, pre and post operative photographs were superimposed and the position of keypoints compared. In the AP view these were the jowl position, modiolus and alar base and in the lateral view the cervicomental angle and jowl angle (defined as the angle subtended by the maximum point of the jowl with the mandible).
- Validated scales for subjective assessment were used to corroborate the measured outcomes for jowl and neck. To minimize confounding features, photographs were cropped to exclude, hair, clothing, eyes and background. The region specific Scale Summit II aesthetic score (Narins et al 2003) was used in the assessment of neck volume, jowl, marionette and nasolabial areas by two independent raters who were not involved in the original surgery (one plastic surgeon and one aesthetics specialist nurse). The overall appearance of the lower face was assessed using the Global Aesthetic Improvement Score (GAIS) (Sattler et al 2012, Narins et al 2012) by five independent raters (one plastic surgeon, two nurses, two non-medical professionals). Photos were assessed blinded to the rater, and presented in random order.
Results/Complications:
- Objective measurements: The jowl elevated in vertical height by 6mm after facelift surgery. The correction was maintained at 5.5 years follow up (p<0.0001). The cervicomental angle decreased by 13 degrees after facelift surgery, with partial relapse of 69% at 5.5 years.
- Region specific Subjective assessment (Scale Summit II scores): Scores showed significant improvement in all areas following a facelift (jowl, nasolabial and marionette, p<0.0001, neck p=0.0007). At 5.5 years, no subjective worsening of any area was noted except the neck.
- Overall Subjective assessment (Global Aesthetic Improvement Scores):Scoring suggested that 76% patients will still look younger 5.5 years after a facelift than they did pre-operatively.
Conclusion:
Patients seeking facelift surgery will often ask “how long will it last doctor?”. To date there is little scientific data to allow the surgeon to give them any honest indication of durability. This study provides validated evidence for the first time that positive aesthetic changes from facelift surgery are maintained over several years. Improvements are maintained most efficiently in the jowl and marionette regions, but to a lesser degree in the neck. The measured objective changes were corroborated by validated subjective assessments.
The longevity of a facelift technique should not be considered in isolation. A long-lasting but abnormal looking facelift is clearly undesirable. The present study included assessment of alar base and commisure width, neither of which changed in the short or long term post-surgery. Patients can be reassured that their mouth will not be widened (a common concern) but their “facial mood” will improve because of a consistent upward change in commissural angle.
References:
Bray D, Henstrom DK, Cheney ML, Hadlock TA.
Arch Facial Plast Surg. 2010 Sep-Oct;12(5):352-4
Narins RS, Brandt F, Leyden J, Lorenc ZP, Rubin M, Smith S.
Dermatol Surg. 2003 Jun;29(6):588-95.
Sattler G, Carruthers A, Carruthers J, et al.
Validated assessment scale for neck volume.
Dermatol Surg. 2012 Feb;38(2 Spec No.):343-50. doi: 10.1111/j.1524-4725.2011.02253.x.
Narins RS, Carruthers J, Flynn TC, et al.
Validated assessment scales for the lower face
Dermatol Surg. 2012 Feb;38(2 Spec No.):333-42. doi: 10.1111/j.1524-4725.2011.02247.x.