As the U.S. population ages and the growing acceptance of plastic surgery extends to all ages, older patients are now undergoing procedures more frequently than ever before. This raises the question of whether this is safe practice and are these older patients at an increased risk of complications because of their age. On the surface, age is associated with a perception of being weaker and more susceptible to disease and injuries.
At the annual meeting of the American Society of Plastic Surgeons in Chicago last week, a study was presented evaluating the rate of complications rate amongst younger vs older plastic surgery patients. In this paper, the CosmetAssuree company (independent insurance company that offers protection from the costs of medical complications for certain cosmetic surgery procedures) provided data over a five year period (2008 to 2013) of their reported complications and their ages. Patients over 65 years old (mena age 69 years old) had a complication rate of 1.94% which was not statistically different than the 1.84% complication rate amongst younger patients. (mean age 39 years old) No differences in complication rates occurred despite the higher number of medical issues and weights in the older patient group. Even with looking at the upper ranges of the older group (80 years or older), the complication rate only rose slightly to 2.2%.
This study also showed that the proportion of facial procedures amongst the older group was much higher than in the younger group. (63% vs. 12%) It is no surprise that the older patients had more facial procedures than body contouring which is well known to tail off from age 60 and older. So to some degree the decreased rate of complications may have been partially altered by the procedural bias that happens with age. Despite that the length of a facelift may be just as long or longer than a tummy tuck for example, there are natural big differences in the rate and type of complications that can occur between a smaller face than the larger abdominal area.
But even looking at facial procedures, the older patients fared just as well. This has been previously reported in the June 2011 issue of the journal Plastic and Reconstructive Surgery in the paper entitled ‘The Safety of Rhytidectomy in the Elderly’. In looking at over 200 patients (divided into over or under age 65) over a three year period by a single surgeon, the complication rates were comparable between the two age groups. (3% vs 2% for major complications, 6% vs 6% for minor complications) Thus indicating that age alone is not an independent risk factor in facelift surgery.
While these studies show that cosmetic surgery is just as safe in the elderly as in the young, it is important to remain vigilant in the planning and workup of the older patient. A good medical workup including laboratory studies and EKG should have been done in the previous six months before the surgery. Specific attention should be paid to their cardiopulmonary history and clearance from their physician. Operative times and the number of procedures should be ‘reasonable’ and not require prolonged recovery times or extended periods of immobilization. Safety and a low rate of complications in the elderly is dependent as much on what their plastic surgeon does as much as their own remarkable tolerance to surgical insult.
Dr. Barry Eppley
Indianapolis, Indiana