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Original Investigation |

Objective Assessment of Perceived Age Reversal and Improvement in Attractiveness After Aging Face Surgery

A. Joshua Zimm, MD1,2; Milad Modabber, MSc3; Vinay Fernandes, MD4; Kian Karimi, MD5; Peter A. Adamson, MD, FRCSC1
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto School of Medicine, Toronto, Ontario, Canada
2currently with the Division of Facial Plastic Surgery, Department of Otolaryngology, Lenox Hill Hospital and Manhattan Eye, Ear & Throat Institute, New York, New York
3currently a medical student at McMaster University DeGroote School of Medicine, Hamilton, Ontario, Canada
4Department of Otolaryngology–Head and Neck Surgery, University of Toronto School of Medicine, Toronto, Ontario, Canada
5currently in private practice, Santa Monica, California
JAMA Facial Plast Surg. 2013;15(6):405-410. doi:10.1001/jamafacial.2013.268.
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Importance  Primary reasons why patients pursue aesthetic facial surgery are to look younger and more attractive; however, there is minimal literature about the effect of aesthetic facial surgery on perceived age and attractiveness.

Objectives  To objectively and quantitatively evaluate the degree of perceived age change and improvement in attractiveness following aesthetic facial surgical procedures.

Design  Prospective evaluation by independent raters of preoperative and postoperative photographs of 49 consecutive patients who underwent aesthetic facial surgery between July 4, 2006, and July 22, 2010. The photographs of these patients were presented to 50 blinded raters, each of whom was randomly assigned to 4 rater groups. Raters were asked to estimate the age of each patient in the photographs presented and to rate the patient’s attractiveness on a scale of 1 to 10.

Setting  Facial plastic surgery private practice in Toronto, Ontario, Canada.

Participants  Patient inclusion criteria consisted of primary facial surgical procedures with a minimum 6-month follow-up period, use of standardized photographs, and no cosmetic procedures in the intervening period. Raters were chosen from the province of Ontario, randomly assigned to 1 of 4 rater groups, and blinded to the objectives of the study.

Main Outcomes and Measures  The mean “years saved” (true age minus guessed age) and change in attractiveness scores after facial aesthetic surgery.

Results  The mean overall years saved following aesthetic facial surgery was 3.1 years (range, −4.0 to 9.4 years). There was a small but insignificant increase in attractiveness scores in postprocedural photographs relative to preprocedural photographs (P > .54).

Conclusions and Relevance  In this study, aesthetic facial surgery was effective in reducing the apparent age of patients but did not consistently improve their attractiveness.

Level of Evidence  4.

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Figures

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Figure 1.
Variation in Years Saved by Procedure

Years saved is the true age minus the guessed age.

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Figure 2.
Distribution of Attractiveness Scores

The histogram compares scores for before-and-after surgery photographs.

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Figure 3.
Mean Attractiveness Scores of After Photographs Minus the Mean Attractiveness Scores of Before Photographs

Shown are the mean scores by each of 50 raters for 49 patients.

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Figure 4.
Raters Tended to Score Younger Patients as More Attractive Than Older Patients

The trend is the same in before-and-after surgery photographs.

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Figure 5.
Increases in Attractiveness Scores Following Procedures

Eighteen patients underwent upper facial rejuvenation, 3 patients underwent lower facial rejuvenation, and 28 patients underwent upper and lower facial rejuvenation.

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Figure 6.
Box Plots Showing the Mean Attractiveness of Male and Female Patients Before and After Cosmetic Surgery

Boxes enclose the middle 50% of the observations, and vertical lines extend to the smallest and largest values, excluding outliers (circle). Outliers are data points that are greater than 1.5 times the height of the box.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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