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Posted | 4 comments

Reality Check: How Much Younger And Hotter Can You Get With Plastic Surgery?

Sobriety Check: How Much Younger And Hotter Can You Get With Plastic Surgery?

Last week, a small part of the Internet broke when a report published in JAMA Facial Plastic Surgery said that patients who underwent a face lift, brow lift or eyelid surgery looked only 3.1 years younger and marginally more attractive after.

Despite the positive reception the study received in the medical community, as the news made its way down the media food chain, the headline of the findings were maligned.

The reactionary buzz ranged from ridicule to outrage, suggesting the preverbal wool has been pulled over patient’s eyes the entire time, as though people just got the memo that plastic surgery isn’t a magic wand.

The cost!  The downtime!  The pain!

All this for 3.1 years and barely breaking a 6 on the 1-10 scale?

Yep. But I say this is actually healthy fodder for the discussion on aging, beauty, and patient expectations, and that the majority who reported on it missed the point.

But first, three clarifying points about the study, lest you’re eyeballs skimmed the headlines only:

1. Only anti-aging facial plastic surgery was studied. 

The patients studied were between aged 49 to 73, and had a combination of upper and/or lower eyelid surgery (blepharoplasty) and/or brow-lift, a neck lift or a full face lift.

The study did not measure nose jobs, or other types of structural facial plastic surgeries that can be incredibly transformative.

Further, because the study only looked at the face, the body was discounted in the youth/hotness equation.  I point this out because you can have the smoothest, tightest, wrinkle free face, but if you have terrible posture, a soft mid section and shuffle instead of stride, you’re sending signals of “older”.

2. Patients who used Botox, lasers and fillers were excluded.

Understanding the goal of the study was to measure the surgical outcomes, it’s a shame that non-invasive treatments were excluded, especially because age spots, discoloration and wrinkles play an equal role in revealing age.

3. The before/after pictures weren’t evaluated by the same person.

In the spirit of removing any bias, the raters were either exposed the before pictures, OR the after pictures, not both. While this created an exceptionally strong acid test (which I commend), it removes the power of the before and after transformation.

4. Patient confidence/satisfaction wasn’t measured.

To me, what’s flawed about doing so is that I suspect in real life, the measure of patient satisfaction is likely to be compared to where they were before, and people telling them how refreshed they look.

On the surface, if a 55 year old looks 50, but inside feels like a slinkly 45, on the prowl for a new job or a mate, then shouldn’t that be an equal success metric?

Ok, so here’s why I think this study if GOOD:

It sets patient expectations, and recalibrates the goal of plastic surgery to look refreshed, not different.

Understandably, a lot of emotion is attached to undergoing the knife, but the reality is, good anti-aging plastic surgery is subtle and barely detectable. It’s you, only rested.

It’s not you, coming out looking Angelina Jolie if that’s not what you looked before. If you want something more drastic, keep in mind that sometimes, the grass on the other side is asphalt.

It makes us think about what old even looks like anymore, and what “good old” looks like.

One interesting factoid in the study was that the raters who saw the “before” pictures on average rated the patients as 2.1 years younger than their chronological age.

I’m not surprised, because if you asked me what 47 looks like, I wouldn’t be able to tell you. Patricia Heaton?  Juliette Binoche? Connie Britton?  I honestly have no idea.

I think it terms of decades (she’s in her early thirties), or bucket people as millennial, middle age-ish, Boomers or grandparents. And if you’re looking a little elderly, a facelift may help, but most of the time that’s only the tip of the iceberg.

What I hope this study will do, is illuminate the other factors that contribute to looking younger; lifestyle, weight, vitality, skin, etc.

Even better, would be if we stopped talking in terms of young and old as though one were good and the other bad.  They’re just different phase of life and biologically impossible to replicate.

And it’s a little sad, when we think good looks like erasing all the merit badges of time.

I think we can do better.  What do you think?

4 Comments

  1. I was at a party the other night and came face to face with a woman of undefined age between 50 and 60: her face was smooth, very pale and very tight, her lips were slightly inflated and, to me, it didn’t convey youth or even relaxation but just trying too hard. Maybe she was 58 and looked 55 – so what? Our expression changes and that is the giveaway. Looking less tired and refreshed, I understand and support. Trying to look marginally younger by means of extreme surger is passe (or, at least, I would like to think so).
    On an aside, I happened to catch the Godfather on tv again last night – when Marlon Brando is told his son Sonny is dead, the camera panned to a close up and Brando conveys grief, disbelief and pain just by moving his eyebrows and the muscles in his forehead. Oustanding acting skills at work and I couldn’t help wonder about what all those Botox’ed actors are losing by trying to look younger.

  2. “3. The before/after pictures weren’t evaluated by the same person.
    In the spirit of removing any bias, the raters were either exposed the before pictures, OR the after pictures, not both. While this created an exceptionally strong acid test (which I commend), it removes the power of the before and after transformation.” –this I think it pretty critical. Add the fact that, as you say, people don’t really know what 58, or whatever, looks like, the fact that people with these surgeries were judged 3.5 years younger sounds pretty good to me.

    You also raise a good point: for a lot of people, it’s not about looking younger, so much as just looking more refreshed or rested or not angry. People also tend to focus on specific areas of their face that they don’t like: jowls, saggy cheeks, etc. In my opinion, the ideal is that lifting the cheeks just lifts the cheeks–no extra stretching or plumping. The result is slightly higher cheeks, which is what the person presumably wanted to begin with, the younger appearance is a kind of bonus.

    So, yeah. I think this paper is great. Hopefully it will help dispel some of the misconceptions about facial plastic surgery, helping people have more realistic goals (or realize that these goals just aren’t worth it for them) and be a little more suspicious of docs that talk about surgery like it’s some sort of time machine. Lots of people would pay 12K to look ten years younger. Not so many will pay that for smoothed out jowls and reduced eye bags. Being aware of what your money, time and suffering are actually likely to get you is good.

  3. My short comment, having had an extensive amount of post-baby plastic surgery as well as modest amounts of Botox and fillers (I’m 46), is that anything we do only ever enhances how we truly feel inside about ourselves. All of these procedures are simply enhancements to the natural beauty that is conveyed through our words, deeds, connections to other people and the unique way we move through the world.

    • Beautifully said.

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