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Patients that present for a plastic surgery consultation requesting a facelift always have a standard set of concerns and questions. Once they find out what a facelift really is their initial concern is that they don’t want to look unnatural or have a ‘wide-swept’ look. While everyone wants the best result possible, they don’t want to be overdone. Few patients come in wanting their face to be pulled as tight as possible no matter if that type of result is longer-lasting.

The inevitable question then arises, and understandably so, about how long does a facelift last? While it is acknowledged that a facelift is not a permanent operation, they want to know if the money they are spending will last more than a few short years. The answer to the facelift longevity question is affected by many variables such as the type of facelift performed, skin type of the patient, aging genetics of each patient and other environmental and lifestyle issues. (e.g., sun exposure, smoking) Numerous studies in the past give variable ranges of the sustained benefits of a facelift, often numbering anywhere from 7 to 12 years after surgery.

In the December 2012 issue of the journal Plastic and Reconstructive Surgery, a paper entitled ‘ How Long Does A Facelift Last? Objective and Subjective Measurements over a 5-Year Period was published. In this study the use of standardized photographs, objective measurements and a scoring system was used to study over a ten year period 50 primary facelift patients at 5.5 years after surgery. By objective measurements, the jowls showed a 21% relapse in position after five years. The cervicomental angle had a relapse of 69% in sharpness after five years. By subjective assessment, scores showed significant improvement in all areas following a facelift including the jowls, nasolabial folds and marionette lines. At 5.5 years after surgery, there was no subjective worsening of any facial area except for the neck. Subjective assessment also indicated that 76% of patients still appeared younger 5.5 years after a facelift than before having it done.

This study is interesting not only because it shows persistent improvement in appearance over 5 years after a facelift but that differential aging occurs. While the jowl, nasolabial and marionette lines remain well corrected over the duration of the study, the most noticeable area of relapse is in the neck. In essence, the neck is the most unstable area of a facelift and is the first to show recurrent aging. (i.e., loss of correction)

Why might the neck not hold up as well as those structures above the jaw line after a facelift? There are numerous explanations including the thinner and less elastic skin that often exists in the neck and that much of the pull and tissue resuspension of a facelift is lateral or closer to the ear rather than more directly in the midline of the neck. Regardless of the reason, patients need to be counseled before surgery that the dramatic change in the profile of the neck may be the most unstable over time.

As this reported study shows, the results of a facelift remain gratifying at five years after surgery. But the result does suffer some deterioration over this time period that is most reflected in the neck and the profile of the cervicomental angle

Dr. Barry Eppley

Indianapolis, Indiana

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