The limits of cosmetic surgery
People who get facial plastic surgery often assume that they will look younger and more appealing afterward. But a new study, the first to try to quantify attractiveness after a face-lift, brow-lift or eyelid surgery, found only a tiny, insignificant increase in attractiveness. The study, published online in JAMA Facial Plastic Surgery on Thursday, also found that patients looked, on average, only three years younger, as judged by independent viewers who assessed photos of patients before and after cosmetic surgery.
The findings will probably provide scant comfort to the more than 120,000 American men and women who last year got face-lifts, a procedure that marketing efforts often claim can turn the clock back a decade.
Dr A Joshua Zimm, the lead author of the study and a facial plastic surgeon at Lenox Hill Hospital in Manhattan, said, "I don't want people to think, 'Oh, if I get a face-lift, I'll only look three years younger.' This study includes people who just had an eyelift or a brow lift."
For the study, 50 raters looked at randomly assigned binders of 49 patients, ages 42 to 73, who had undergone cosmetic procedures with Dr Peter A Adamson, a surgeon in Toronto. No one rater saw pre- and post-operative shots of the same person, lest they deduce the study's aim, and at a six-month follow-up, patients were excluded if they had had a nose job or injections of anti-wrinkle medicines like Botox.
The raters estimated patients' ages to be about 2.1 years younger, on average, than their chronological age before surgery, and 5.2 years younger after surgery, an overall difference of 3.1 years, with minimal changes in attractiveness. A 2012 study of Dr Adamson's patients had found, on average, a seven-year reduction in perceived age, but that study used less rigorous criteria.
Several plastic surgeons credited the researchers for the rigor of the current study, including the use of blinded raters.
"It's a big deal that a study is presenting a negative finding," said Dr Eric Swanson, a plastic surgeon in Leawood, Kansas, who was not involved in the current research. In 2011, he conducted the first of only a handful of studies that have sought to quantify apparent age change after facial surgery.
"They are saying that patients didn't have a change in attractiveness."
Dr Zimm, the lead author, said he was surprised by the "insignificant finding for attractiveness." He noted that 60 per cent of raters scored patients between 4 and 6 on a scale of 1 to 10, with 10 being the most comely. He guessed that future research "will show a difference in attractiveness, if we have a larger sample size, and just analyze attractiveness alone."
The very nature of what we consider "old" today also played a role in the results, said Nancy Etcoff, a psychologist at Harvard Medical School and the author of "Survival of the Prettiest: The Science of Beauty". This study looked only at surgical results, and didn't use laser resurfacing to address brown splotches and or fat injections to add volume. But a loss of plumpness in a face reads old, as do wrinkles or age spots, she said.
"They're looking at a face that looks older in some ways, and younger in some ways," she said. "It's difficult for the raters, and confusing."
Allan Imbraguglio, a 55-year-old information technology specialist in Washington, got upper and lower eyelid surgery in April. He wasn't looking "to shave off five years or three years of my age," he said. "I just wanted to feel better about myself." He said that eliminating his "tired look" helped him project the image of someone "up for the work of a younger person."
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