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Original Investigation
March 16, 2017

Association of Face-lift Surgery With Social Perception, Age, Attractiveness, Health, and Success

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
JAMA Facial Plast Surg. Published online March 16, 2017. doi:10.1001/jamafacial.2016.2206
Key Points

Question  What is the effect of face-lift surgery on social perceptions of age, attractiveness, health, and success?

Findings  In this survey of 483 blinded, naive observers rating independent patient images, face-lift surgery was associated with patients appearing younger, more attractive, healthier, and more successful.

Meaning  These findings highlight the multidimensional positive association of face-lift surgery and implications regarding social perceptions beyond restoring a youthful appearance.


Importance  Evidence quantifying the influence of face-lift surgery on societal perceptions is lacking.

Objective  To measure the association of face-lift surgery with observer-graded perceived age, attractiveness, success, and overall health.

Design, Setting, and Participants  In a web-based survey, 526 casual observers naive to the purpose of the study viewed independent images of 13 unique female patient faces before or after face-lift surgery from January 1, 2016, through June 30, 2016. The Delphi method was used to select standardized patient images confirming appropriate patient candidacy and overall surgical effect. Observers estimated age and rated the attractiveness, perceived success, and perceived overall health for each patient image. Facial perception questions were answered on a visual analog scale from 0 to 100, with higher scores corresponding to more positive responses. To evaluate the accuracy of observer age estimation, the patients’ preoperative estimated mean age was compared with the patients’ actual mean age. A multivariate mixed-effects regression model was used to determine the effect of face-lift surgery. To further characterize the effect of face-lift surgery, estimated ordinal-rank change was calculated for each domain.

Main Outcomes and Measures  Blinded casual observer ratings of patients estimated age, attractiveness, perceived success, and perceived overall health.

Results  A total of 483 observers (mean [SD] age, 29 [8.6] years; 382 women [79.4%]) successfully completed the survey. Comparing patients’ preoperative estimated mean (SD) age (59.6 [9.0] years) and patients’ actual mean (SD) age (58.4 [6.9] years) revealed no significant difference (t2662 = −0.47; 95% CI, −6.07 to 3.72; P = .64). On multivariate regression, patients after face-lift surgery were rated as significantly younger (coefficient, −3.69; 95% CI −4.15 to −3.23; P < .001), more attractive (coefficient, 8.21; 95% CI, 7.41-9.02; P < .001), more successful (coefficient, 5.82; 95% CI, 5.05 to 6.59; P < .001), and overall healthier (coefficient, 8.72; 95% CI, 7.88-9.56; P < .001). The ordinal rank changes for an average individual were −21 for perceived age, 21 for attractiveness, 16 for success, and 21 for overall health.

Conclusions and Relevance  In this study, observer perceptions of face-lift surgery were associated with views that patients appeared younger, more attractive, healthier, and more successful. These findings highlight observer perceptions of face-lift surgery that could positively influence social interactions.

Level of Evidence  NA.