Wednesday, November 10, 2010

Longevity of SMAS Face Lift

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

I think it is safe to say that all plastic surgeons have been asked, “How long will my face lift last?”  As pointed out, by Dr. Sundine and colleagues (first reference article) this question is difficult to answer using our current literature.  They tried to answer the question focusing specifically on the two-layer superficial musculoaponeurotic system (SMAS) face lift.
To do this, Sundine and colleagues conducted a retrospective chart review of 42 patients who underwent secondary face lifts performed by the senior author from January of 2001 to December of 2008. Patients who had their primary face lift performed by another surgeon were excluded.  The charts were reviewed for the dates of the initial surgery and subsequent operations, patient data, procedures performed, and complications. The patient photographs were also reviewed.
The average age at the time of the primary face lift was 50.7 years (range, 34.9 to 69.9 years), and the average age at the time of the secondary face lift was 61.9 years (range, 43.6 to 77.2 years).
The average length of time from the primary to secondary face lift was 11.9 years (range, 1.0 to 34.5 years). ….
One glaring shortcoming of the study is the failure of the authors to contact every patient the senior author performed a primary face lift (there were 299 during the time frame) to determine whether any patients received a secondary face lift with another surgeon.
So while the over-simplified answer may be “approximately 10 years,” there really is no simple answer.  Patients give many reasons for desiring a second facelift.  (second reference)
Readers of this article will already know that people have a universe of reasons for having a face lift. In practice, one commonly notes not only unhappiness with the mirror but also the loss of a spouse or the anticipation of finding one: the patient's social milieu and group dynamics (face lifts as a rite of passage). Some people perceive an advantage in finding or maintaining employment, all reasons that may have little to do with the face itself but with life conditions of the person requesting the procedure. In other words, subjectivity and life forces are major factors, and the decision to have such a procedure may have little relationship to how the patient actually appears.
Biological factors such as skin quality, facial weight, and the age at which the initial procedure is performed significantly affect both the quality of the initial result and its duration, and the same cultural and personal forces remain. There is no distinct tissue endpoint for undergoing a secondary lift, just as there is no distinct biological point at which a primary lift becomes “necessary.” With so many factors to be considered, the longevity of any type of face lift remains a difficult question to answer with any certainty.
In addition, to the above there are the constraints of life that may prevent a patient from returning for a desired facelift – poor health, financial concerns, family reasons, and perhaps even a poor experience the first time.

Longevity of SMAS Facial Rejuvenation and Support; Sundine, Michael J.; Kretsis, Vasileios; Connell, Bruce F.; Plastic & Reconstructive Surgery. 126(1):229-237, July 2010.; doi: 10.1097/PRS.0b013e3181ce1806
Discussion: Longevity of SMAS Facial Rejuvenation and Support; Lambros, V.; Stuzin, J. M.; Plastic & Reconstructive Surgery. 126(1):238-239, July 2010; doi: 10.1097/PRS.0b013e3181dab6f3
The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study [Outcomes Article]; Friel, M.T.; Shaw, R. E.; Trovato, M. J.; Owsley, J. Q.; Plastic & Reconstructive Surgery. 126(1):245-257, July 2010; doi: 10.1097/PRS.0b013e3181dbc2f0
Discussion: The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study [Outcomes Article]; Pusic, A.L.; Klassen, A. F.; Scott, A. M.; Cano, Stefan J.; Plastic & Reconstructive Surgery. 126(1):258-260, July 2010; doi: 10.1097/PRS.0b013e3181dbba19

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