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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.

The question that remains is do the deeper operations make a significant difference in the results, Antell says. "I think the answer is no," he says. "The risk of complications and problems, generally speaking, increase the deeper you go."

Deeper is not necessarily better, Antell says. "If there is a simpler operation that can work just as effectively or nearly as effectively, I would go with that procedure."

But, he adds, that's a matter of choice on the part of the doctor. "Each of the doctors was doing the operation that they thought would be best for that patient."

In other words, "if you are playing golf and know can get on the green with a five iron, then you should use the five iron even though another golfer can get on the green with an eight iron," he says.

Although the results may be wonderful, getting a facelift is a big decision. No surgery is without risks, including cosmetic surgery. For example, there are risks associated with the use of painkillers, anesthesia, and antibiotics. Smokers are also at increased risk for complications including delayed wound healing and scarring. Prolonged operating time and use of general anesthesia may also increase the risk of blood clots in the veins, Antell notes.

People undergoing plastic surgery should be in good physical health prior to surgery, he says.

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