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Follow on Google News | New JAMA FPS study findings about facial rejuvenation surgery are flawed and prejudiced- part 1By: Anticlock- Age Reversal Clinic & Medispa *Senior Consultant, Plastic Surgery, Fortis Hospital, Mohali, India. *Director, AntiClock- Age Reversal Clinic & Medispa, Chandigarh, India. Email: kmkapoor@gmail.com Recently published study in JAMA Facial Plastic Surgery journal, titled ‘Objective assessment of perceived age reversal and improvement in attractiveness after aging face surgery’ by Zimm et al has concluded that mean perceived improvement in age after surgical facial rejuvenation procedures is only 3.1 years with no significant improvement in the attractiveness after surgery. However, looking closely at the study and comparing it with a similar study in the same journal & from the same practice, we have found that study is biased due to inclusion of larger number of less extensive facial surgical procedures in sample which lead to lower number of ‘yeas saved after surgery’ in the study. This bias against surgical facial procedures could be due to the fact that the lead investigator has a major interest in promoting non-surgical facial rejuvenation procedure over surgical procedures. The biggest flaw of this study is its wide variation from a similar study that came out from the same practice, titled ‘Perceived age change after aesthetic facial surgical procedures quantifying outcomes of aging face surgery’. This waspublished in JAMA FPS (earlier called Arch Facial Plastic Surgery) in 2012 with Dr P Adamson as co-author. The study, which had analyzed 60 patients operated by Dr Adamson, had concluded that patient ages were estimated to be 7.2 years younger than their chronological age after facial rejuvenation surgery. In contrast within one year of publication of this study, the newer study published in JAMA again with Dr P Adamson as a co-author, has brought down the ‘years saved’ from facial rejuvenation surgeries by nearly 60% to 3.1 years. Part I. The study design is flawed and sample selection is biased: In the previous 2012 study (henceforth mentioned as Study 1), 60 patients operated by Dr P Adamson from January 2005 to December 2008, were selected. While in the current 2013 study (henceforth mentioned as Study 2), 49 consecutive patients operated by Dr P Adamson from July 2006 to July 2010 were selected. Despite using an overlapping set of patients operated by single surgeon in both the studies, there is such a wide variation in the ‘ years saved’ after facial rejuvenation surgery in them (7.2 years in study 1 versus 3.1 years in study 2). 1. A major flaw of Study 2 is that the duration between pre operative pictures taken at the time of surgery and postoperative picture during follow-up was not same for all the patients, the time range for taking post op pictures varied from 6 to 36 months. While in Study 1, all the post op pictures used were take 6 months after surgery. Results in 36-month post surgery picture cannot ideally be considered same as those seen in a 6 months postoperative picture. The possible explanation could be that the patient at 36 months postoperative point has further aged chronologically by 3 years and also the effect of surgery has decreased to some extent due to factors like aging/ gravity, during this period. It is a normal practice in clinics to photograph patients during subsequent follow-up visits but it was intriguing why even 3 years post surgery photos were included in the sample when the aim of the study was to objectively assess ‘ number of years saved’. 2. Another discrepancy seems to be that in Study 1, patients who had undergone face- and neck-lift surgery, ‘number of years saved’ were 5.74 years after surgery while for the same patients in Study 2 number of years saved were only 3.2 years. With the same surgeon operating patients in same clinic during overlapping time period in both studies, such a big difference in results is inexplicable. 3. In Study 1, there were three groups of patients, with Group 1 having 22 patients (face- and neck-lift); group 2 had 17 patients (face-and neck-lift & upper AND lower Blepharoplasty) On the other hand in Study 2, out of 49 patients, 46 patients had Upper face rejuvenation (upper and /or lower blepharoplasty and /or brow lift; note the word OR here, which was not there in sample of Study 1) as a common factor which, as a well known fact, contributes much less to age reversal compared to a more major procedure of face- and neck-lift surgery. In study 2, out of total 49 patients, only 3 were patients of face- and neck-lift, 28 patients had face- and neck-lift + upper and /or lower blepharoplasty and/or brow lift, while 18 patients had only upper face surgical procedures (upper and /or lower blepharoplasty and /or brow lift). The sample selected in study 2 is grossly biased towards less extensive and lesser number of procedures to deliberately get a lower ‘years saved after surgery’ score. 4. Another point to be noted in Study 2 is that out of total 21 patients in sub group ‘upper facial rejuvenation or lower facial rejuvenation’ 5. Although the mean ‘years saved’ after aesthetic facial surgery in Study 2 was 3.1 years , the maximum value in this range was 9.4 years. This point has not been highlighted much as this piece of data clearly shows that in some patients, surgery is capable of shaving off nearly 10 years from a patient’s age and such patients, if carefully selected, could achieve to look almost 10 years younger after surgery. 6. The method to calculate ‘Attractiveness’ cont.>> http://www.prlog.org/ End
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