Association Between Facial Rejuvenation and Observer Ratings of Youth, Attractiveness, Success, and Health

Abstract

IMPORTANCE Surgical procedures for the aging face-including face-lift, blepharoplasty, and brow-lift-consistently rank among the most popular cosmetic services sought by patients. Although these surgical procedures are broadly classified as procedures that restore a youthful appearance, they may improve societal perceptions of attractiveness, success, and health, conferring an even larger social benefit than just restoring a youthful appearance to the face. OBJECTIVES To determine if face-lift and upper facial rejuvenation surgery improve observer ratings of age, attractiveness, success, and health and to quantify the effect of facial rejuvenation surgery on each individual domain. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical experiment was performed from August 30 to September 18, 2016, using web-based surveys featuring photographs of patients before and after facial rejuvenation surgery. Observers were randomly shown independent images of the 12 patients; within a given survey, observers saw either the preoperative or postoperative photograph of each patient to reduce the possibility of priming. Observers evaluated patient age using a slider bar ranging from 30 to 80 years that could be moved up or down in 1-year increments, and they ranked perceived attractiveness, success, and health using a 100-point visual analog scale. The bar on the 100-point scale began at 50; moving the bar to the right corresponded to a more positive rating in these measures and moving the bar to the left, a more negative rating. MAIN OUTCOMES AND MEASURES A multivariate mixed-effects regression model was used to understand the effect of face-lift and upper facial rejuvenation surgery on observer perceptions while accounting for individual biases of the participants. Ordinal rank change was calculated to understand the clinical effect size of changes across the various domains after surgery. RESULTS A total of 504 participants (333 women, 165 men, and 6 unspecified; mean age, 29 [range, 18-70] years) successfully completed the survey. A multivariate mixed-effects regression model revealed a statistically significant change in age (-4.61 years; 95% CI,-4.97 to-4.25) and attractiveness (6.72; 95% CI, 5.96-7.47) following facial rejuvenation surgery. Observer-perceived success (3.85; 95% CI, 3.12-4.57) and health (7.65; 95% CI; 6.87-8.42) also increased significantly as a result of facial rejuvenation surgery. CONCLUSIONS AND RELEVANCE The data presented in this study demonstrate that patients are perceived as younger and more attractive by the casual observer after undergoing face-lift and upper facial rejuvenation surgery. These procedures also improved ratings of perceived success and health in our patient population. These findings suggest that facial rejuvenation surgery conveys an even larger societal benefit than merely restoring a youthful appearance to the face. LEVEL OF EVIDENCE NA.

Two multinational, observational surveys investigating perceptions of beauty and attitudes and experiences relating to aesthetic medical procedures

“…Respondents had a generally positive view of aesthetic medical procedures and had observed favorable changes in both physical appearance and attitude among people using them. This echoes findings that casual observers considered Caucasian women undergoing procedures to look younger and more attractive 16. As expected, perceptions and attitudes were generally more positive among users than nonusers, with nonusers more concerned about the safety and efficacy of treatments.…”

Facial Appearance and Psychosocial Features in Orthognathic Surgery: A FACE-Q- and 3D Facial Image-Based Comparative Study of Patient-, Clinician-, and Lay-Observer-Reported Outcomes

“…We have addressed the social aspects of face perception (e.g., attractiveness and emotional expressions) as they have consistently been recognized as fundamental to human social interaction [12,13,14,15,17,18,19,20,21,22,23,38,39,40,41,42,43,54,55,56,57]. However, research on the OGS population should be expanded to additional facial−perception−associated areas of interest, such as neuropsychological mechanisms, through a multidisciplinary research collaboration with groundbreaking engineering technologies (e.g., brain scanning, direct stimulation of the brain, visual adaptation, and single−cell recording) [58,59,60].…”

“…However, only a few OGS studies have adopted the FACE-Q tool [10,11]. In this setting, the impact of different surgical interventions, including OGS procedures, on facial aesthetic and social perceptions, has been demonstrated using the panel assessment tool, a metric that is centered on clinician-reported outcome (ClinRO, professionals using medical or dental judgments) and observer-reported outcome (ObsRO, judgments from laypersons with no formal training) principles [12,13,14,15,16,17,18,19,20,21,22,23].…”

Postoperative revisits and readmissions after facelift surgery

“…It has been demonstrated that after facelift surgery, patients are viewed by lay observers as significantly younger, more attractive, more successful, and overall healthier. 1 Patients with low self-esteem show a statistically significant improvement in self-esteem after facelift surgery. 2 Rhytidectomy is generally an outpatient, elective procedure that is performed in healthy, older patients.…”

“…This outpatient procedure can provide surgical outcomes that may not be achievable with nonsurgical alternatives. It has been demonstrated that after facelift surgery, patients are viewed by lay observers as significantly younger, more attractive, more successful, and overall healthier . Patients with low self‐esteem show a statistically significant improvement in self‐esteem after facelift surgery .…”