Younger patients achieve better results and higher satisfaction after facelift surgery

Younger patients with "early or minimal signs of facial aging" achieve better results and higher satisfaction rates at least a decade after facelift surgery, according to a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Because of their superior long-term results, patients younger than 50 years old undergoing "maintenance facelifts" should be considered preferable candidates for facial rejuvenation surgery, suggests the new report by Drs. Tom S. Liu and John Q. Owsley of California Pacific Medical Center, San Francisco.

Patients Under 50 Have Best Long-term Results
In a previous study, researchers found that patients who underwent facelift surgery at older ages had lower satisfaction scores and more variable results, compared to younger patients. For the new study, Drs. Liu and Owsley compared the short-term and long-term patient satisfaction ratings with expert analysis of follow-up photographs. They analyzed differences in long-term outcomes for patients in three age groups: patients younger than 50, 50 to 60 years, and over 60 years old at the time of facelift surgery.

Consistent with the previous study, younger patients had higher and more consistent satisfaction scores at both short- and long-term follow-up. Those subjective ratings were supported by expert analysis of follow-up photos, which showed that patients who underwent facelift surgery before age 50 had "remarkable maintenance of their youthful appearance."

In contrast, at the time of surgery, patients in the over-60 group already had "significant facial aging changes." At long-term follow-up, they still looked more youthful than other people of the same age—however, they had signs of "regression" in the five facial areas graded by plastic surgeons. Patients in the 50-to-60 age group had intermediate results.

The patient satisfaction ratings were generally consistent with the expert ratings of before-and-after photographs. On long-term follow-up using a 5-point scale (5 being most satisfied), patients in the under-50 age group continued to rate all facial areas with 4's and 5's, compared to 2's to 5's for the 50-to-60 group and 2's and 3's for the over-60 group.

Younger Patients May Be 'Preferred' for Facelift Surgery
Although the study was small, it seems to support the impression of experienced plastic surgeons that "Younger patients who have facelifts (<50 years old) have longest lasting results with less noticeable postoperative changes," according to Drs. Liu and Owsley. Although the visible signs of aging seem mild in patients under 50, they represent the "tip of the iceberg" of the effects of aging underneath the skin. "Although equal in the number of years elapsed, the facial aging of a patient from age 40 to 50 is much less dramatic than the same patient from age 50 to 60," the researchers add.

Younger patients interested in facial rejuvenation may be steered away from a facelift, or undergo limited or nonsurgical procedures to "buy time." "However, these…are also the same patients who would benefit most from surgical facial rejuvenation or so-called 'maintenance facelift,' the researchers write. Not only will the results last longer, but the initial change is generally less dramatic and noticeable than in older patients.

As a result, Drs. Liu and Owsley believe that patients under 50 should not only be considered for a facelift, but perhaps considered the group most likely to achieve excellent, long-lasting results. As such, they conclude, "a 'maintenance' facelift should be offered to and even preferred in younger patients as a surgical option for facial rejuvenation."