According to the American Society for Aesthetic Plastic Surgery, 127,512 facelifts, 152,123 blepharoplasties (eyelid surgeries), and 26,514 forehead lifts were performed in the US in 2010. That is a lot of surgery and a lot of dollars ($845 million on facelifts alone). Most often these procedures are performed because of a desire on the part of the person having the surgery to look younger (and presumably better). But do these surgical procedures really lead to a more youthful appearance?
If you ask people that have had a facelift (plus or minus blepharoplasty or a forehead lift), if they think they look younger, you get a resounding, “Yes” as you will see in the results reported below. And that’s a good thing because they paid a lot of money out-of-pocket and went through quite a bit of hassle and not a little discomfort because of their choice to have cosmetic surgery. The problem with using self-assessment as an outcome, however, is that it is subjective and, of course, biased (“I can’t have spent all that money and not gotten something, right?”)
Any objective evidence?
So, the question is if there is any objective evidence that facial rejuvenation surgery really rejuvenates. It surprised me to learn that there really haven’t been any good studies documenting the effectiveness of the interventions – until now.
Enter Dr. Eric Swanson, a cosmetic surgeon at the Swanson Center in Leawood, Kansas. Dr. Swanson felt it was high time that his specialty objectively evaluate the outcomes of facial rejuvenation procedures. He states, in a recent publication in the Journal of Plastic, Reconstructive and Aesthetic Surgery (Sept 2011), “the stark fact remains that, since the first facelifts were performed over 100 years ago, no facial rejuvenation technique has been validated.”
“Nothing—no skin cream, laser treatment, or operation—has ever been proven to make a person look younger.”
In order to answer the question of whether the procedures produced the desired result, Dr. Swanson designed a very clever study. He took before and after photos of 75 of his consecutive facial rejuvenation patients, being careful to use similar photographic standards (neutral expression, not smiling, the same degree of chin elevation). The subjects were not allowed to wear makeup or jewelry, nor could they have had any cosmetic procedures, such as filler injections or Botox in between the before and after photos. They also had to wait a minimum of 6 months for the “after” photos so the results would not be distorted because of facial swelling.
Once he got all of these photos, he assembled them into two different books. Although the books were a mixture of before and after photos, neither book contained the before and after photo of any given patient. The photos were only frontal view and they were all full-page.
Next, Dr. Swanson took the books to an annual “Women’s Life” Exposition where he rented a booth. 198 people visited the booth and agreed to guess the age of the people in one of the books. Then he compared the guessed age of each patient with their real (chronologic) age at the time the photo was taken. Here is what he found:
- The mean reduction in apparent (guessed) age was 6 years; the range was .8 – 14.2 years
- The average reduction for a facelift alone was 4.6 years
- Laser resurfacing resulted in 2.5 years of reduction
- Blepharoplasty and forehead lifts each reduced apparent age by 2 years
- Smokers had a greater average reduction in guessed age than nonsmokers, but they tended to look older than their chronologic age prior to surgery
- Non-smokers, on the other hand, were guessed to be 5.6 years younger than their chronologic years even prior to surgery
- No patient was guessed to be older after the surgery than before (thank heavens!)
- 96.7% of patients thought they looked younger after surgery with a mean reduction of 11.9 years
Did it answer the question?
The study really only answers the question: “Do Dr. Swanson’s facial rejuvenation surgeries rejuvenate?” However, it is a definite contribution in a field where objective evidence has been lacking. I think one of the most interesting aspects of this study is that the apparent age reduction is a lot less than most patients and cosmetic surgeons believe – Dr. Swanson points out that a 10-year reduction is often bantered about at plastic surgery meetings.
We will have to wait to learn if other surgeons in other parts of the country caring for different types of patients have the same results. Dr. Swanson’s methodology of standardized photos could easily be replicated in other practices. Perhaps the American Society of Aesthetic Plastic Surgeons could sponsor a large, multi-center study that would move the field firmly into the Age of Outcomes. Meanwhile, kudos to Dr. Swanson for being willing to objectively study whether his own surgeries produce the results his patients dreamed of.