Skip to main content
SpringerLink
Log in

Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery

  • Original Articles
  • Face and Neck Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

This study evaluates change in practice patterns in facelift surgery based on a 15-year review of tracer data collected by the American Board of Plastic Surgery as part of the Continuous Certification process.

Methods

Tracer data for facelift was reviewed from 2006 to 2021. The 15-year collection period was divided into an “early cohort (EC)” from 2006 to 2014 and a “recent cohort (RC)” from 2015 to 2021.

Results

Of 3400 facelifts (1710 EC/1690 RC) performed, 18% were done in hospital and 76% were done in an accredited office facility. Ninety one percent of patients were female with an average age of 61 years. There was an increase in the number of secondary facelifts (4% EC vs 18% RC; p < 0.001) and an increased number of patients concerned about volume loss/deflation (25% EC vs 37% RC; p < 0.001). The surgical approach to the SMAS involved plication (40%), flaps (35%), SMASectomy (22%) and MACS lift (6%). One percent of facelifts were subperiosteal and 8% skin-only. Significantly more surgeons used the lateral SMAS flap (14% EC vs 18% RC, p < 0.005), while less used an extended SMAS flap (21% vs 18%; p = 0.001) and MACS lift (10% EC vs 6% RC; p = 0.021) techniques. The concomitant use of facial fat grafting is becoming more common (15% EC vs 24% RC, p = 0.0001).

Conclusions

A 15-year review of ABPS tracer data provides an excellent venue for the objective assessment of the current status of facelift surgery, and key changes in practice patterns during that time.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kearney AM, Shah N, Zins J, Gosain AK (2021) Fifteen-year review of the American Board of Plastic Surgery maintenance of certification tracer data: clinical practice patterns and evidence-based medicine in zygomatico orbital fractures. Plast Reconstr Surg 147(6):967e–975e

    Article  CAS  PubMed  Google Scholar 

  2. Rokni AM, Kearney AM, Brandt KE, Gosain AK (2021) Clinical practice patterns and evidence-based medicine in secondary cleft rhinoplasty: a 14-year review of maintenance of certification tracer data from the American Board of Plastic Surgery. Cleft Palate Craniofac J 58(9):1110–1120

    Article  PubMed  Google Scholar 

  3. Shah ND, Kearney AM, Zins J, Gosain AK (2022) Evolving trends in unilateral cleft lip repair based on continuous certification by the American Board of Plastic Surgery. J Craniofac Surg 33(2):502–505

    Article  PubMed  Google Scholar 

  4. Yuksel SS, Kearney AM, Taub PJ, Gosain AK (2021) Clinical practice patterns in nonsyndromic craniosynostosis: a review of continuous certification tracer data from the American Board of Plastic Surgery. J Craniofac Surg 32:2029–2034

    Article  PubMed  Google Scholar 

  5. Guyuron B (2010) An evidence-based approach to face lift. Plast Reconstr Surg 126:2230–2233

    Article  CAS  PubMed  Google Scholar 

  6. Stuzin JM (2008) MOC-PSSM CME article: face lifting. Plast Reconstr Surg 121:1–19

    Article  PubMed  Google Scholar 

  7. Warren RJ, Aston SJ, Mendelson BC (2011) Face lift. Plast Reconstr Surg 128:747e–764e

    Article  PubMed  Google Scholar 

  8. Mustoe TA, Park E (2014) Evidence-based medicine: face lift. Plast Reconstr Surg 133:1206–1213

    Article  CAS  PubMed  Google Scholar 

  9. Derby BM, Codner MA (2017) Evidence-based medicine: face lift. Plast Reconstr Surg 139:151e–167e

    Article  CAS  PubMed  Google Scholar 

  10. Gupta V, Winocour J, Shi H, Shack RB, Grotting JC, Higdon KK (2016) Preoperative risk factors and complication rates in facelift: analysis of 11,300 patients. Aesthet Surg J 36:1–13

    Article  PubMed  Google Scholar 

  11. Rohrich RJ, Ghavami A, Constantine FC et al (2014) Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg 133:756e–767e

    Article  CAS  PubMed  Google Scholar 

  12. Rohrich RJ, Ghavami A, Constantine FC, Unger J, Mojallal A (2014) Lift-and-fill face lift: integrating the fat compartments. Plast Reconstr Surg 133:756e–767e

    Article  CAS  PubMed  Google Scholar 

  13. Marten TJ, Elyassnia D (2015) Fat grafting in facial rejuvenation. Clin Plast Surg 42:219–252

    Article  PubMed  Google Scholar 

  14. Matarasso A, Elkwood A, Rankin M, Elkowitz M (2000) National plastic surgery survey: face lift techniques and complications. Plast Reconstr Surg 106(5):1185–1195

    Article  CAS  PubMed  Google Scholar 

  15. DeFatta RJ, Williams EF III (2008) Fat transfer in conjunction with facial rejuvenation procedures. Facial Plast Surg Clin North Am 16:383–390

    Article  PubMed  Google Scholar 

  16. Sinno S, Mehta K, Reavey PL, Simmons C, Stuzin JM (2015) Current trends in facial rejuvenation: an assessment of ASPS members’ use of fat grafting during face lifting. Plast Reconstr Surg 136(1):20e–30e. https://doi.org/10.1097/PRS.0000000000001329. (PMID: 26111329)

    Article  CAS  PubMed  Google Scholar 

  17. Sinclair NR, Kochuba A, Coombs DM, Couto RA, Charafeddine AH, Grow J, Matarasso A, Zins JE (2022) Face Lift practice patterns: an american society of plastic surgeons member survey, 2000 and 2020. How much have we changed? Plast Reconstr Surg 149(6):1096e–1105e

    Article  CAS  PubMed  Google Scholar 

  18. Jacono AA, Alemi AS, Russell JL (2019) A meta-analysis of complication rates among different SMAS facelift techniques. Aesthet Surg J 39:927–942

    Article  PubMed  Google Scholar 

  19. Berry MG, Davies D (2010) Platysma-SMAS plication facelift. J Plast Reconstr Aesthet Surg 63:793–800

    Article  CAS  PubMed  Google Scholar 

  20. Rees TD, Aston SJ (1977) A clinical evaluation of the results of submusculo-aponeurotic dissection and fixation in face lifts. Plast Reconstr Surg 60(6):851–859. https://doi.org/10.1097/00006534-197712000-00002. (PMID: 928550)

    Article  CAS  PubMed  Google Scholar 

  21. Webster RC, Smith RC, Papsidero MJ et al (1982) Comparison of SMAS plication with SMAS imbrication in face lifting. Laryngoscope 92(8 Pt 1):901–912 (PMID: 7047959)

    Article  CAS  PubMed  Google Scholar 

  22. Ivy EJ, Lorenc ZP, Aston SJ (1996) Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies. Plast Reconstr Surg 98:1135–1143

    Article  CAS  PubMed  Google Scholar 

  23. Becker FF, Bassichis BA (2004) Deep-plane face-lift vs. superficial musculoaponeurotic system plication face-lift: a comparative study. Arch Facial Plast Surg 6:8–13 (PMID: 14732637)

    Article  PubMed  Google Scholar 

  24. Zins J, Grow J, Kochuba A, Matarasso A, Sinclair N, Charafeddine A, Coombs D, Couto R (2022) Face lift practice patterns: an American society of plastic surgeons member survey, 2000 and 2020. How much have we changed? Plast Reconstr Surg 149(6):1096e

    Article  PubMed  Google Scholar 

  25. Zager WH, Dyer WK (2005) Minimal incision facelift. Facial Plast Surg 21:21–27 (PMID: 15988652)

    Article  CAS  PubMed  Google Scholar 

  26. Chang S, Pusic A, Rohrich RJ (2011) A systematic review of comparison of efficacy and complication rates among face-lift techniques. Plast Reconstr Surg 127:423–433 (PMID: 21200240)

    Article  CAS  PubMed  Google Scholar 

  27. Alpert BS, Baker DC, Hamra ST, Owsley JQ, Ramirez O (2009) Identical twin face lifts with differing techniques: a 10-year follow-up. Plast Reconstr Surg 123:1025–1033

    Article  CAS  PubMed  Google Scholar 

  28. Kamer FM, Frankel AS (1998) SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison. Plast Reconstr Surg 102(3):878–881

    Article  CAS  PubMed  Google Scholar 

  29. Beale EW, Rasko Y, Rohrich RJ (2013) A 20-year experience with secondary rhytidectomy: a review of technique, longevity, and outcomes. Plast Reconstr Surg 131(3):625–634. https://doi.org/10.1097/PRS.0b013e31827c70f1. (PMID: 23142942)

    Article  CAS  PubMed  Google Scholar 

  30. Bratzler DW, Houck PM; Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society (2004) Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 38:1706–1715

  31. Dauwe PB, Pulikkottil BJ, Scheuer JF, Stuzin JM, Rohrich RJ (2015) Infection in face-lift surgery: an evidence-based approach to infection prevention. Plast Reconstr Surg 135:58e–66e

    Article  CAS  PubMed  Google Scholar 

  32. Gupta R, John J, Gupta M, Shaheen K (2022) Venous thromboembolism prophylaxis in plastic surgery patients undergoing facelift. Aesthet Surg J Open Forum. https://doi.org/10.1093/asjof/ojac024. (PMID: 35601235; PMCID: PMC9119342)

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chopan M, Samant S, Mast BA (2020) Contemporary analysis of rhytidectomy using the tracking operations and outcomes for plastic surgeons database with 13,346 patients. Plast Reconstr Surg 145(6):1402–1408

    Article  CAS  PubMed  Google Scholar 

  34. Wan D, Dayan E, Rohrich RJ (2019) Safety and adjuncts in face lifting. Plast Reconstr Surg 144(3):471e–484e

    Article  CAS  PubMed  Google Scholar 

  35. Maricevich MA, Adair MJ, Maricevich RL, Kashyap R, Jacobson SR (2014) Facelift complications related to median and peak blood pressure evaluation. Aesthetic Plast Surg 4:641–647

    Article  Google Scholar 

  36. Baker D, Stefani W, Chiu E (2005) Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases. Plast Reconstr Surg 116:1973–1985

    Article  CAS  PubMed  Google Scholar 

  37. Grover R, Jones BM, Waterhouse N (2001) The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts. Br J Plast Surg 54:481–486

    Article  CAS  PubMed  Google Scholar 

  38. Abboushi N, Yezhelyev M, Symbas J, Nahai F (2012) Facelift complications and the risk of venous thromboembolism: a single center’s experience. Aesthet Surg J 32:413–420

    Article  PubMed  Google Scholar 

  39. Ramanadham SR, Costa CR, Narasimhan K, Coleman JE, Rohrich RJ (2015) Refining the anesthesia management of the face-lift patient: lessons learned from 1089 consecutive face lifts. Plast Reconstr Surg 135:723–730

    Article  CAS  PubMed  Google Scholar 

  40. Ramanadham SR, Mapula S, Costa C, Narasimhan K, Coleman JE, Rohrich RJ (2015) Evolution of hypertension management in face lifting in 1089 patients: optimizing safety and outcomes. Plast Reconstr Surg 135:1037–1043

    Article  CAS  PubMed  Google Scholar 

  41. Beer GM, Goldscheider E, Weber A, Lehmann K (2010) Prevention of acute hematoma after face-lifts. Aesthetic Plast Surg 34:502–507

    Article  CAS  PubMed  Google Scholar 

  42. Jones B, Grover R (2004) Avoiding hematoma in cervicofacial rhytidectomy: a personal 8-year quest. Reviewing 910 patients. Plast Reconstr Surg 113:381–387

    Article  PubMed  Google Scholar 

  43. Niamtu J (2005) Expanding hematoma in face-lift surgery: literature review, case presentations and caveats. Dermatol Surg 31:1134–1144

    Article  CAS  PubMed  Google Scholar 

  44. Tiourin E, Barton N, Janis JE (2021) Methods for minimizing bleeding in facelift surgery: an evidence-based review. Plast Reconstr Surg Glob Open 9:e3765

    Article  PubMed  PubMed Central  Google Scholar 

  45. Jones BM, Grover R, Hamilton S (2007) The efficacy of surgical drainage in cervicofacial rhytidectomy: a prospective, randomized, controlled trial. Plast Reconstr Surg 120:263–270

    Article  CAS  PubMed  Google Scholar 

  46. Couto RA, Charafeddine A, Sinclair NR, Nayak LM, Zins JE (2020) Local infiltration of tranexamic acid with local anesthetic reduces intraoperative facelift bleeding: a preliminary report. Aesthet Surg J 40(6):587–593. https://doi.org/10.1093/asj/sjz232

    Article  PubMed  Google Scholar 

  47. Kochuba AL, Coombs DM, Kwiecien GJ, Sinclair NR, Zins JE (2021) Prospective study assessing the effect of local infiltration of tranexamic acid on facelift bleeding. Aesthet Surg J 41(4):391–397. https://doi.org/10.1093/asj/sjaa198. (PMID: 32644111)

    Article  PubMed  Google Scholar 

  48. Cohen JC, Glasgold RA, Alloju LM, Glasgold MJ (2021) Effects of intravenous tranexamic acid during rhytidectomy: a randomized, controlled double-blind pilot study. Aesthet Surg J 41(2):155–160. https://doi.org/10.1093/asj/sjaa072. (PMID: 32173730)

    Article  PubMed  Google Scholar 

  49. Rohrich RJ, Cho MJ (2018) The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg 2:507–515

    Article  Google Scholar 

  50. Sinclair NR, Coombs DM, Kwiecien G, Zins JE (2021) How to prevent and treat complications in facelift surgery, part 1: short-term complications. Aesthet Surg J Open Forum 3(1):ojab007. https://doi.org/10.1093/asjof/ojab007

    Article  Google Scholar 

  51. Rees TD, Liverett DM, Guy CL (1984) The effect of cigarette smoking on skin-flap survival in the face lift patient. Plast Reconstr Surg 73(6):911–915. https://doi.org/10.1097/00006534-198406000-00009. (PMID: 6728942)

    Article  CAS  PubMed  Google Scholar 

  52. Taub PJ, Matarasso A (2016) E-cigarettes and potential implications for plastic surgery. Plast Reconstr Surg 138(6):1059e–1066e. https://doi.org/10.1097/PRS.0000000000002742. (PMID: 27879608)

    Article  CAS  PubMed  Google Scholar 

  53. Rohrich RJ, Narasimhan K (2016) Long-term results in face lifting: observational results and evolution of technique. Plast Reconstr Surg 138(1):97–108. https://doi.org/10.1097/PRS.0000000000002318

    Article  CAS  PubMed  Google Scholar 

  54. Narasimhan K, Stuzin JM, Rohrich RJ (2013) Five-step neck lift: integrating anatomy with clinical practice to optimize results. Plast Reconstr Surg 132(2):339–350. https://doi.org/10.1097/PRS.0b013e3182958b6f

    Article  CAS  PubMed  Google Scholar 

  55. Mendelson BC, Tutino R (2015) Submandibular gland reduction in aesthetic surgery of the neck. Plast Reconstr Surg 136:463–471

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Feldman JJ (2014) Neck lift my way: an update. Plast Reconstr Surg 134(6):1173–1183 (PMID: 25415087)

    Article  CAS  PubMed  Google Scholar 

  57. Auersvald A, Auersvald LA (2018) Management of the submandibular gland in neck lifts: indications, techniques, pearls, and pitfalls. Clin Plast Surg 45(4):507–525 (Epub 2018 Aug 10 PMID: 30268240)

    Article  PubMed  Google Scholar 

  58. Rohrich RJ, Sinno S, Vaca EE (2019) Getting better results in facelifting. Plast Reconstr Surg Glob Open 7(6):e2270 (PMID: 31624678)

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We wish to acknowledge Dr. Keith Brandt, Executive Director of the American Board of Plastic Surgery, for careful review of this manuscript to insure that it complies with the standards for data reporting by the ABPS.

Funding

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. There are no external funding sources for this study.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA

    Michael J. Stein & Alan Matarasso

  2. Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital of Northwestern Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA

    Nikhil Shah & Arun K. Gosain

  3. Data Harbor Solutions, Hinsdale, IL, USA

    John Harrast

  4. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

    James E. Zins

Authors
  1. Michael J. Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Harrast
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James E. Zins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alan Matarasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arun K. Gosain
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arun K. Gosain.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human or Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stein, M.J., Shah, N., Harrast, J. et al. Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. Aesth Plast Surg 48, 793–802 (2024). https://doi.org/10.1007/s00266-023-03841-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03841-x

Keywords

Search

Navigation