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The Limits of Cosmetic Surgery

november 26, 2016

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Patients 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 postoperative 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, Kan., 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 percent of raters scored patients between 4 and 6 on a scale of 1 to 10, with 10 being the most comely, so there was not much variation in overall attractiveness scores. 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.”

Dr. James M. Stuzin, a Miami plastic surgeon who specializes in face-lifts, thought the study’s findings had limited generalizability. “A lot of patients show better improved perceived age and attractiveness than what was noted in this study,” he said. The study did not include pictures and, without them, “we don’t know what technique was utilized,” he said. “Definitely technique and a surgeon’s skill level influences results.”

Dr. Val Lambros, a plastic surgeon in Newport Beach, Calif., lauded the researchers’ conscientiousness and their good-faith effort to quantify perceived age improvement and attractiveness after surgery. ‘It’s remarkably hard to do a study like this,” he said.

However, he cautioned, “assigning numbers has an incredible potential to be misused.” Imagine the competing advertisements, he said, with one surgeon saying, “My operation makes people look 4.2 years younger” and another crowing, “Mine makes patients look like Girl Scouts.”

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.”

That said, he hardly complained when a colleague told him he looked 50.