Younger? Better? Or Not? What plastic surgeries really make a difference?
A recent study published in JAMA Facial Plastic Surgery made headlines with “surprising” results showing that one surgeon’s cosmetic surgeries made almost no impact on patients’ attractiveness, and made minimal impact on how youthful they looked.
The results may have surprised the general public, but they were less shocking to experienced plastic surgeons like me who reviewed the article in detail. In conversations with colleagues, including several members of the American Society for Aesthetic Plastic Surgery, a few key elements stood out. The study reviewed the impact of just one doctor’s surgeries in restoring youthfulness or creating attractiveness. His results may, or may not, be reflective of the specialty at large—and no pictures were included in the publication.
Notably, the majority of the patients in this study underwent periorbital surgeries (upper lid, blepharoplasty, lower lid blepharoplasty, and brow lifts).
All manner of "lift" surgeries – browlifts, eyelifts, facelifts – are designed to bring the patient’s appearance to where it was years before, not to change the fundamental facial morphology. If you are unhappy with your fundamental facial structure, a lift surgery is unlikely to give you the desired change in “attractiveness”.
Facial attractiveness is determined by the shape and proportions of parts (nose, chin, cheeks, and jawline), and how they relate one to another. It is the symmetry of these facial features that is most important. The size and shape of these features is dictated by their skeletal components. Operations that change the size and shape of these features can alter attractiveness, but operations that change the way that skin and musculature sit on the skeleton will serve to help patients look the same, only rejuvenated.
In other words, the bone structure is the foundation for facial appearance and the symmetry that leads to attractiveness. Operations that will make a real impact on appearance are those that manipulate this symmetry—procedures like rhinoplasty (changing nasal bones) or cheek bone, chin and jaw implants.
In short, lifts can help patients to appear younger, but cannot reasonably be expected to change their objective level of attractiveness. If you are happy with your underlying facial structure and are looking to regain some of the key attributes of youth, these procedures can be an ideal solution. If you are looking for more dramatic shift in your appearance, you should consider procedures that would bring your facial features into balance.
Of course, the right procedure executed by the wrong surgeon will yield unnatural or exaggerated results. We have all seen victims of these surgeries—people who look perpetually surprised; whose eyes are strangely round and hollow; whose necks appear uneven or pulled too taut; or whose lower eyelids merge unnaturally with overly flat and windswept cheeks.
When evaluating potential plastic surgeons, remember that surgeons board-certified by the American Board of Plastic Surgery® go through extensive specialized training and examinations, and meet rigorous recertification requirements. These doctors can be trusted to help you choose the right procedure, whether your goal is to look a few years younger or to change your appearance more fundamentally.