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.
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.
And finally, when choosing a plastic surgeon, make sure that he or she is board certified in plastic surgery.
After you find the right doctor, no matter what procedure is decided on, Antell says today's facelifts earn high marks. "I'd give them an A. They clearly work and people look better for a significant amount of time. You will look eight to 10 years younger than you would have without the surgery for the rest of your life."