title: Association of Face-lift Surgery With Social Perception, Age, Attractiveness, Health, and Success.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Nellis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ira D
authors.initials: ID
authors.lastname: Papel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Theda C
authors.initials: TC
authors.lastname: Kontis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kofi D O
authors.initials: KDO
authors.lastname: Boahene
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Bater
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Ishii
mesh_terms: D000124:Achievement; D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000523:psychology*; D001244:Association; D001294:Attitude to Health; D001504:Beauty; D003697:Delphi Technique; D000066499:Facial Recognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015361:Rhytidoplasty / Q000523:psychology*; D012938:Social Perception; D011795:Surveys and Questionnaires; D055815:Young Adult