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Facelift Not Enough, May Need Implants


The facelift of the future may be a two-step process, according to researchers at the University of Rochester Medical Center. Tightening the skin to reduce wrinkles may actually be the second step, while restoring facial structure, perhaps with implants, will be the first.

A facelift, also known as a rhytidectomy, is the fifth most popular surgical cosmetic procedure in the United States, according to the American Society for Aesthetic Plastic Surgery, with 94,247 surgeries performed in 2009 for both women and men. A facelift tightens underlying tissues, smoothes loose skin on the face and neck, and removes excess fat.

A new study, which was presented at the American Association of Plastic Surgeons, suggests that tightening loose skin is not enough to produce the youthful appearance patients seek. To achieve that look, individuals in the future may need to first have a procedure that restores the underlying structure. Why?

Physicians at the University of Rochester, who also worked with colleagues from Harvard and Stanford universities, noted that as people age, there are significant changes in bone structure, especially the jaw bone, and those result in a loss of definition in the lower part of the face, which contributes to sagging skin and an older look.

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To arrive at their conclusions, the researchers evaluated 120 facial computed tomography (CT) scans that had not been taken for cosmetic surgery purposes. The scans were classified according to age and gender: 20 males and 20 females in each of three age groups: ages 20 to 36, 41 to 64, and 65 and older. A computer program was used to measure the length, width, and angle of the jaw bone in each scan.

The researchers noted that the angle of the jaw increases noticeably as people age, and this causes less definition in the lower portion of the face. Howard N. Langstein, MD, professor and chief of plastic and reconstructive surgery at the University of Rochester Medical Center remarked that their measurements showed that there is “a significant decline in the jaw’s volume as a person ages, and therefore less support of soft tissue of the lower face and neck.”

Therefore, unless the loss of bone volume is corrected, it will contribute to sagging skin, a loss of definition in the jaw area, and an aging neck. Langstein noted that “Though we have always known that bones change over time, until now, the extent to which it causes an aged appearance was not appreciated.”

The study’s authors believe that knowing facial bone structure changes as people age will help plastic surgeons develop procedures that will allow them to restore youthful appearance for their patients. Such procedures may include cheek and chin implants, according to Robert Shaw, MD, a plastic surgery resident, prior to a facelift. Implants will allow surgeons to suspend soft tissue and a chance “to rebuild the structure that time has worn away, in addition to lifting and reducing excess skin.”

In the future, individuals who go looking for a more youthful appearance may be presented with a two-step procedure, one involving implants or another way to restore the underlying structure, and the facelift itself. Although this study did not address the issues of additional cost, recovery time, and possible complications and side effects, these are factors future facelift patients will need to consider.

American Society for Aesthetic Plastic Surgery
University of Rochester Medical School, news release Mar. 23, 2010