Behind the scenes: How we determined patients still look younger five years after facelift surgery
One of the questions people enquiring about facelift surgery will ask most frequently is "How long will it last?" Surprisingly, there is very little scientific literature to enable doctors to give an honest and straightforward answer so they tend to pluck a number out of the air.
To study patients over a long period of time is difficult since generally once they have had their operation and are happy, they tend not to return. Making comparisons from photographs is also difficult since the photographs have to be all taken in the same way so that they are comparable. Since 2001, I have used a standardized photographic system to take pictures of all my patients both before and after surgery. From 2001 to 2011, I carried out more than 1,700 deep plane facelifts. Trawling through my photographic archive we found 50 of these patients who had come back at an average of 5 and a half years after their facelift surgery for an unrelated reason such as seeking advice about a different aspect of their appearance. This gave me the opportunity to re-photograph them. So, my recent study about how long a facelift lasts, was based on these 50 patients for whom we had photographs before their facelift surgery, at routine follow-up between 3 and 6 months and then at longer term follow-up at an average of 5 and a half years after their operation. We wanted to try to measure changes in various aspects of the face as a result of the operation and to see how well those changes had been maintained over a long period of time.
We used an innovative computer program which allowed us to mark certain key points on the face such as the jowl, neck, etc., and measure changes in position of those points after facelift. We found that there were major improvements in the jowl, mouth to chin (marionette) lines and nose to mouth (nasolabial) lines and also a significant improvement in the angle between the neck and the chin. When we looked at the long term follow-up photographs, we found that the positive changes in the lower part of the face remained constant over the long (average 5 and a half years) follow-up period. The neck remained improved but drifted towards its pre-operative position more than the other areas that we measured. The width of the mouth did not change and neither did the width of the nose which were positive features - patients often ask whether their mouth will become wider. The corner of the mouth tends to move upwards a little - a change which is also maintained.
In addition to the computer program, we used two assessment techniques where photographs were shown to another plastic surgeon, an aesthetic nurse and two lay people to see what changes they thought had occurred. In order to try and reduce error, the photographs were cropped so that the hair, clothing, etc. were removed which can have a big influence on how one perceives the picture. Essentially the observations were identical to the changes which the computer measurements had told us.
We can now reassure patients that deep plane facelift surgery will make them look better and happier, and changes which will remain constant for at least 5 and a half years on average. It will not create adverse changes in the mouth or nose.
In the future we hope to extend the period of study and it may well be that these positive changes will remain for 10 years or more but we will have to wait to get evidence beyond the present 5 and a half years.
You can learn more about the facelift study in this month's edition of Plastic Surgery Update.