Contemporary Analysis of Rhytidectomy Using the Tracking Operations and Outcomes for Plastic Surgeons Database with 13,346 Patients

Abstract

Background: Rhytidectomy is a popular procedure for facial rejuvenation, but an up-to-date, comprehensive, and broadly representative appraisal is lacking. Methods: A cohort of patients undergoing rhytidectomy between 2008 and 2016 was identified from the Tracking Outcomes in Plastic Surgery database. Perioperative data and patient characteristics were analyzed with respect to adverse events. Multivariate logistic regression was used to identify association of complications with various risk factors. Results: A total of 13,346 patients with a mean age of 60 years underwent rhytidectomies and a total of 31,206 Current Procedural Terminology procedures. Most were healthy women with an American Society of Anesthesiologists class of 1 or 2 (98 percent). On average, 2.3 procedures were performed in 3.8 hours per patient, and blepharoplasty was the most common adjunctive procedure. Fifty percent of operations were performed in office-based settings, and general anesthesia utilized in 63 percent of cases. The incidence of adverse events was 5.1 percent, with hematomas and infections as the most frequent surgical complications. Male gender, obesity, current smoker, duration, combined procedures, general anesthesia, and office-based surgery were associated with increased odds of adverse events. Conclusions: This is the largest outcomes analysis of face-lift surgery in a patient population solely representative of board-certified plastic surgeons. Rhytidectomy is a very safe procedure when performed by board-certified plastic surgeons. Nevertheless, risk factors for complications are identified, several of which can be affected by surgeon choice of surgical venue, additive procedures, duration of operation, and type of anesthetic. The study provides a standard reference for professionals when counseling patients and in guiding clinical practices. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Face Lift Practice Patterns: An American Society of Plastic Surgeons Member Survey, 2000 and 2020. How Much Have We Changed?

“…Although the response rate (11 percent) was less than ideal, it is similar to that of previous ASPS face lift surveys. 1,4 Furthermore, a nonresponder analysis found that more than 20 percent of surveyed surgeons who practice predominantly aesthetic surgery responded, and general demographics of ASPS members, nonresponders, and responders are comparable ( see Document, Supplemental Digital Content 2 , which shows the nonresponder analysis, http://links.lww.com/PRS/F52).…”

Lumbar Artery Perforator Flaps

“…Extended operative durations are also associated with greater complications. 24,25 Nevertheless, with greater experience, it is anticipated that operative duration will improve. Other drawbacks may include patient positioning in prone or decubitus, and staged procedures for bilateral reconstruction.…”

How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications

“… 49 A 2020 review of the TOPS database identified a 0.89% incidence of infection following facelift surgery. 8 This study, however, did not identify the depth of infection, causative organism, or treatment. While the reported incidence is low, large retrospective reviews and surveys almost certainly underestimate the true incidence of infection, particularly minor cases of cellulitis.…”

“… 9 A 2020 database review of 13,346 facelifts identified 2 patients who developed pulmonary emboli (incidence 0.01%). 8 This study did not provide information regarding DVT prophylaxis or anesthetic modality.…”

“… 7 A more recent review of the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database found a similar hematoma rate of 1.97%. 8 Risk factors for hematoma and techniques to reduce its incidence have been studied extensively.…”