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May 15, 2001 (New York) -- It takes two to do lots of things, including figuring out which facelift technique produces the most natural and age-defying results.

At least that's the logic behind the "twins study," a study comparing facelifts performed by four well-known plastic surgeons on two sets of identical twins.

And after six years, all four facelift techniques showed comparable results in terms of re-establishing a youthful facial contour and avoiding that operated-on look, says researcher Bernard S, Alpert, MD, a plastic surgeon in San Francisco. Alpert announced his findings recently at the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) held here.

In 2000, there were 102,842 facelifts performed in the U.S., making facelifts the fifth most common cosmetic surgery, according to statistics from the ASAPS.

The facelift techniques used differed primarily in how deeply the surgeon cut. The original facelift was a skin-only procedure. An incision was made around the ears and the skin was opened up like a page in a book, brought back, then the excess skin was trimmed and the remaining skin was sewn up. Innovations to the procedure include cutting down to deeper layers of tissue. Some surgeons even go as far as the surface of the bone.

Why study twins? "Because it's the only way to really look at different procedures and see results and really compare them," explains Malcolm D. Paul, MD, the new president of the ASAPS and a plastic surgeon in Newport Beach, Calif.

"You cannot accurately say which works better if you don't operate on the same patients," he tells WebMD. "All results were lasting after six years and the patients in the study were happy. We can be comforted in knowing that modern aesthetic surgical techniques ... can reverse the signs of aging in a very safe way. Every year [facelifts] get better. We are there in terms of creating natural facial rejuvenation that avoids the look of having been operated on."

Each plastic surgeon chooses the technique that they feel most comfortable with, he says.

Darrick Antell, MD, a New York plastic surgeon, has been doing his own research on twins for several years.

"Twins offer us a unique opportunity to study people who are genetically alike, however if they have differences in lifestyle choices, it can affect the rate at which they age," he says. For example, sun exposure, smoking, and intense emotional stress can speed the aging process -- causing wrinkles, age spots, enlarged pores, and leathery skin.

"The most important take-home message of the new study is that all of the people looked better six years later -- no matter which technique was done," Antell tells WebMD.

No one procedure was clearly head and shoulders above the others, he says.

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