Reality Check: How Much Younger And Hotter Can You Get With Plastic Surgery?

8 Aug 2013 at 9:00am

by Becca Smith,

Narcissista is New York ad exec, RealSelf community member, mom, wife, and self-described “beauty veteran” Becca Smith, whose blog,, deliciously and incisively examines the intersection of beauty, anti-aging, and loving (and navigating) life.

Last week, a small part of the Internet broke when a report published in JAMA Facial Plastic Surgery said that patients who underwent a face lift, brow lift or eyelid surgery looked only 3.1 years younger and marginally more attractive after. Despite the positive reception the study received in the medical community, as the news made its way down the media food chain, the headline of the findings were maligned.

The reactionary buzz ranged from ridicule to outrage, suggesting the preverbal wool has been pulled over patient’s eyes the entire time, as though people just got the memo that plastic surgery isn’t a magic wand. The cost! The downtime! The pain! All this for 3.1 years and barely breaking a 6 on the 1-10 scale? Yep.

But I say this is actually healthy fodder for the discussion on aging, beauty, and patient expectations, and that the majority who reported on it missed the point.

But first, three clarifying points about the study, lest you’re eyeballs skimmed the headlines only:

1. Only anti-aging facial plastic surgery was studied.

The patients studied were between aged 49 to 73, and had a combination of upper and/or lower eyelid surgery (blepharoplasty) and/or brow-lift, a neck lift or a full face lift. The study did not measure nose jobs, or other types of structural facial plastic surgeries that can be incredibly transformative. Further, because the study only looked at the face, the body was discounted in the youth/hotness equation. I point this out because you can have the smoothest, tightest, wrinkle free face, but if you have terrible posture, a soft mid section and shuffle instead of stride, you’re sending signals of “older”.

2. Patients who used Botox, lasers and fillers were excluded.

Understanding the goal of the study was to measure the surgical outcomes, it’s a shame that non-invasive treatments were excluded, especially because age spots, discoloration and wrinkles play an equal role in revealing age.


3. The before/after pictures weren’t evaluated by the same person.

In the spirit of removing any bias, the raters were either exposed the before pictures, OR the after pictures, not both. While this created an exceptionally strong acid test (which I commend), it removes the power of the before and after transformation.

4. Patient confidence/satisfaction wasn’t measured.

To me, what’s flawed about doing so is that I suspect in real life, the measure of patient satisfaction is likely to be compared to where they were before, and people telling them how refreshed they look. On the surface, if a 55 year old looks 50, but inside feels like a slinkly 45, on the prowl for a new job or a mate, then shouldn’t that be an equal success metric?

Ok, so here’s why I think this study if GOOD:

It sets patient expectations, and recalibrates the goal of plastic surgery to look refreshed, not different.

Understandably, a lot of emotion is attached to undergoing the knife, but the reality is, good anti-aging plastic surgery is subtle and barely detectable. It’s you, only rested. It’s not you, coming out looking Angelina Jolie if that’s not what you looked before. If you want something more drastic, keep in mind that sometimes, the grass on the other side is asphalt.


It makes us think about what old even looks like anymore, and what “good old” looks like.

One interesting factoid in the study was that the raters who saw the “before” pictures on average rated the patients as 2.1 years younger than their chronological age. I’m not surprised, because if you asked me what 47 looks like, I wouldn’t be able to tell you. Patricia Heaton? Juliette Binoche? Connie Britton? I honestly have no idea. I think it terms of decades (she’s in her early thirties), or bucket people as millennial, middle age-ish, Boomers or grandparents.

And if you’re looking a little elderly, a facelift may help, but most of the time that’s only the tip of the iceberg.

What I hope this study will do, is illuminate the other factors that contribute to looking younger; lifestyle, weight, vitality, skin, etc. Even better, would be if we stopped talking in terms of young and old as though one were good and the other bad. They’re just different phase of life and biologically impossible to replicate.

And it’s a little sad, when we think good looks like erasing all the merit badges of time.

I think we can do better.  What do you think?

Comments (2)

Many patients are not looking to look younger and hotter but may just be striving to look like they feel on the inside. Aging can sometimes leave people looking tired and angry and they often are complimented following facial surgery that they look more "youthful" and "refreshed"!
This article is very interesting. As I am having face works done in a few months, I have spent countless hours looking at before and after pics of women who had facelifts, blephs and brow lifts. The results very widely. Some looked up to 20 years younger, others 10 to 15 and some only a little smoother. I guess a lot depends of facial anatomy, genetics, skin condition, whether the woman is at a healthy weight, smoking, drinking, sun exposure and the skill of the surgeon. Many women still had the same ageing hair style after the lift and that detracted from the improvement of the surgery. If the surgery only takes you back only 2-3 years, I don't think it would be worth the expense IMO. Also, what I have observed from women that I have seen is that a lot of them will have work done on their face but because they do not exercise and are out of shape they have the body/posture of an old woman and move like one. Out of the ones that do exercise, the majority do cardio and end up skinny fat which means, normal weight on the scale but higher body fat in relation to muscle. When women age, they begin to lose muscle mass -as well as bone mass . Muscle looks good and burns calories. So, when you lose muscle, your metabolism slows down, hence the middle age spread plus flabby arms, skinny legs with no muscle tone, poor posture etc. The solution to all that is weightraining. No other form of exercise will sculpt and shape the body like weightraining can.