Plastic surgery today is done literally from head to toe and from the ages of soon after birth to octogenarians. Like never before older patients are undergoing non-surgical and surgical procedures for face and even body enhancements. When a plastic surgeon or a patient is considering surgery in these ‘advanced’ years it would seem logical that the basic success of any surgery, the ability to heal, may be decreased or even impaired. While this may seem to be true, since all bodily functions are known to slow down with age, there are no scientific studies that validate that supposition.
In the November 2014 issue of the journal of Plastic and Reconstructive Surgery, a study was published as ‘Wound Healing in Plastic Surgery: Does Age Matter? An ACS NSQIP Study.’ Using the American College of Surgeon’s NSQIP database, over 25,000 patient records were retrospectively analyzed using a wide variety of parameters from patient age, comorbidities, drug and tobacco use to wound healing problems including infection. Multivariate statistical analysis was done to see how age influenced the development of wound complications such as dehiscence.
There was an overall incidence of surgical wound dehiscence that was under 1%. No differences were found in these wound dehiscence patients when comparing the number of them under 30 years vs those over 60 or 70 years old. There were relevant factors that did affect wound complication and they were well known and expected ones like steroid and tobacco use and being overweight. The authors conclude that n patients undergoing plastic surgery, wound dehiscence is an uncommon complications. Aging was not shown to be associated with increased rate of wound dehiscences.
Wile this study provides retrospective data that age does not affect wound healing in an easily identifiable rate, and I think that is largely true, there are equally if not more relevant questions for older plastic surgery patients. Their overall general health, medications that may be on and the type and length of the plastic surgery procedures must be considered carefully. This is where the older patient really differs from the younger ones. Because of excellent health and the amazing ability of the human body to heal, plastic surgery in younger patients can be more ‘aggressive’ and extensive with still relatively low rates of medical and wound problems. Such an approach in older patients, however, will get both surgeon and patient in trouble. This is why most plastic surgery in older patients is disproportionately focused on the face where the traumatized surface area remains small even if it extremely valuable ‘real estate’.
Dr. Barry Eppley
Indianapolis, Indiana