Facial plastic surgery may turn back the hands of time, but new research suggests it may not, alas, boost attractiveness.
For this small study, 50 strangers were asked to guess the age and subjectively rank the attractiveness of 49 patients after viewing photos of them either before or after facial plastic surgery.
The bottom-line: Surgical intervention shaved a few years off perceived age but did almost nothing to boost patients' overall attractiveness.
What's at issue is patients' expectations, said study lead author Dr. Joshua Zimm, an attending surgeon at Lenox Hill Hospital and Manhattan Eye, Ear and Throat Institute of North Shore-LIJ Health System in New York City.
"When we're doing this kind of surgery I'm telling patients that they'll look fresher, more energetic and less tired, and we have some data in the literature that indicates you will look younger, as we found," Zimm said. "But clearly I cannot say that they will look more attractive."
He emphasized, however, that the findings represent the work of just one surgeon and that the study design had limitations. "This is not the final word on the subject," Zimm said.
"But certainly I think you can take away from this that if you're looking to have aesthetic facial surgery to look younger, we've shown that you will," he said. "Beyond that ... it is not clear that everyone will definitely look more attractive."
Zimm and his colleagues discussed their findings in the Aug. 1 online edition of the journal JAMA Facial Plastic Surgery.
The team focused on clients at a Toronto private-practice facility who had one or more of the following procedures between 2006 and 2010: face lift, neck lift, upper or lower eyelid lift, and brow-lift. The patients ranged from 42 to 73 years old.
Facial photos were taken before surgery and over a six-month follow-up period post-surgery. Makeup and jewelry were banned from the photo sessions, as were additional cosmetic procedures (such as Botox injections or laser skin resurfacing) between the before-and-after photo sessions.
The raters saw either pre-surgery or post-surgery photos of a patient, but never both. Without knowing the purpose of the study, they were asked to estimate the patient's age and to rate their attractiveness on a scale of 1 to 10. They were given no criteria for determining attractiveness so as not to influence their thinking.
Although patients were deemed to look three years younger on average after plastic surgery, any bump in attractiveness was deemed statistically insignificant.
Zimm took pains to note that the findings do not reflect a real-world context, in which patients' relatives and acquaintances will have a very clear frame of reference for assessing both age and beauty. He also suggested that a much larger study would be needed to nail down the impact of facial plastic surgery.
What's more, asking raters to assess age and attractiveness at the same time might have created a "kind of subconscious attractiveness bias," Zimm said.
Still, "at the end of the day the goal is to make people happy, so we have to know what's possible in order to determine if any particular patient is someone I can help," he said.
But a Chicago plastic surgeon said the study is meaningless in that regard.
"Certainly when I see a new patient I have to decide if what the patient is after is achievable or even realistic," said Dr. Laurie Casas, a senior clinician educator at the University of Chicago Pritzker School of Medicine. "And it's a very complex process because the perception of beauty has to be evaluated by both the surgeon and the patient."
The end game is that they want to look more attractive, but this study doesn't get me anywhere with that process because it's impossible to make any sense out of the data," Casas said.
Without a common understanding of what a 1-to-10 attractiveness score actually means, there's no frame of reference, she said. "It's totally subjective, so the results have no meaning," she said.