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The Limits of Cosmetic Surgery By Catherine Saint Louis
Patients who get facial plastic surgery often assume that they will look younger and more appealing afterward. But a new study, the first to try to quantify attractiveness after a face-lift, brow-lift or eyelid surgery, found only a tiny, insignificant increase in attractiveness. The study, published online in JAMA Facial Plastic Surgery on Thursday, also found that patients looked, on average, only three years younger, as judged by independent viewers who assessed photos of patients before and after cosmetic surgery.
The findings will probably provide scant comfort to the more than 120,000 American men and women who last year got face-lifts, a procedure that marketing efforts often claim can turn the clock back a decade.
Dr. A. Joshua Zimm, the lead author of the study and a facial plastic surgeon at Lenox Hill Hospital in Manhattan, said, “I don’t want people to think, ‘Oh, if I get a face-lift, I’ll only look three years younger.’ This study includes people who just had an eyelift or a brow lift.”
For the study, 50 raters looked at randomly assigned binders of 49 patients, ages 42 to 73, who had undergone cosmetic procedures with Dr. Peter A. Adamson, a surgeon in Toronto. No one rater saw pre- and postoperative shots of the same person, lest they deduce the study’s aim, and at a six-month follow-up, patients were excluded if they had had a nose job or injections of anti-wrinkle medicines like Botox.
The raters estimated patients’ ages to be about 2.1 years younger, on average, than their chronological age before surgery, and 5.2 years younger after surgery, an overall difference of 3.1 years, with minimal changes in attractiveness. A 2012 study of Dr. Adamson’s patients had found, on average, a seven-year reduction in perceived age, but that study used less rigorous criteria.
Several plastic surgeons credited the researchers for the rigor of the current study, including the use of blinded raters.
“It’s a big deal that a study is presenting a negative finding,” said Dr. Eric Swanson, a plastic surgeon in Leawood, Kan., who was not involved in the current research. In 2011, he conducted the first of only a handful of studies that have sought to quantify apparent age change after facial surgery. “They are saying that patients didn’t have a change in attractiveness.”
Dr. Zimm, the lead author, said he was surprised by the “insignificant finding for attractiveness.” He noted that 60 percent of raters scored patients between 4 and 6 on a scale of 1 to 10, with 10 being the most comely, so there was not much variation in overall attractiveness scores. He guessed that future research “will show a difference in attractiveness, if we have a larger sample size, and just analyze attractiveness alone.”
The very nature of what we consider “old” today also played a role in the results, said Nancy Etcoff, a psychologist at Harvard Medical School and the author of “Survival of the Prettiest: The Science of Beauty.” This study looked only at surgical results, and didn’t use laser resurfacing to address brown splotches and or fat injections to add volume. But a loss of plumpness in a face reads old, as do wrinkles or age spots, she said.
“They’re looking at a face that looks older in some ways, and younger in some ways,” she said. “It’s difficult for the raters, and confusing.”
Dr. James M. Stuzin, a Miami plastic surgeon who specializes in face-lifts, thought the study’s findings had limited generalizability. “A lot of patients show better improved perceived age and attractiveness than what was noted in this study,” he said. The study did not include pictures and, without them, “we don’t know what technique was utilized,” he said. “Definitely technique and a surgeon’s skill level influences results.”
Dr. Val Lambros, a plastic surgeon in Newport Beach, Calif., lauded the researchers’ conscientiousness and their good-faith effort to quantify perceived age improvement and attractiveness after surgery. ‘It’s remarkably hard to do a study like this,” he said.
However, he cautioned, “assigning numbers has an incredible potential to be misused.” Imagine the competing advertisements, he said, with one surgeon saying, “My operation makes people look 4.2 years younger” and another crowing, “Mine makes patients look like Girl Scouts.”
Allan Imbraguglio, a 55-year-old information technology specialist in Washington, got upper and lower eyelid surgery in April. He wasn’t looking “to shave off five years or three years of my age,” he said. “I just wanted to feel better about myself.” He said that eliminating his “tired look” helped him project the image of someone “up for the work of a younger person.”
That said, he hardly complained when a colleague told him he looked 50.
整形可年輕3歲 魅力卻不增
追求臉部整形的人,往往認為術後一定會看起來更年輕、更有魅力;但美國醫學會「整形外科期刊」首次將拉皮、拉額或眼皮手術後的魅力成果,透過科學方式加以量化發現,整形對於魅力的提升效果微不足道,且術後平均只年輕3歲。
「紐約時報」評論,這是整形業者從獨立評審團得到的誠實結果,它和一般常見的整形效果廣告很不一樣。
全美一年超過12萬人拉皮,他們看了報導,可能不是滋味。
曼哈頓整形醫師齊姆的團隊,調查曾在加拿大多倫多一所整形診所接受臉部整形手術的民眾,項目包括臉部拉皮、脖子拉皮、抬眉手術或眼皮手術,從中隨機選出49人,年齡42歲至73歲。
這些人在手術前後都先拍照存證,拍照時也不得化妝,不得配戴飾品,若術後半年內曾做過隆鼻或注射防皺紋等醫美療程者,並且不能參加評鑑。
所有評鑑參加者都由一家醫院人員與一般民眾組成50人的「評審團」打分數,他們從未看過上述照片,因此完全憑實際觀感評分。
評審團看術前的受測者,推估整體的平均年紀比起真實年齡年輕2.1歲;然而術後,評審估測年齡也較實齡年輕5.2歲,亦即受測者術後平均年輕3.1歲。
雖然整形讓外表變年輕,但對於個人魅力提升方面,術後的加分卻不值一提。
多位整形專家說,研究報告很了不起,因它有膽量誠實公布整形對於魅力提升的負面結果,「你的魅力不會改變」。
不過,齊姆表示,想整形的人也不用太失望,因這項研究針對是只做一項手術的人,例如拉皮、眉或眼皮。其他一些研究則顯示,多重整形的年輕效果不止3年。
55歲的華府資訊科技專家艾倫,今年4月曾接受上、下眼皮手術。他沒指望將歲月刮掉3年、5年,「我只想要自我感覺好一點」。他說,拿掉「疲相」,有助他呈現「一個比較年輕的人的那種幹勁」。
當然,一位同事說他看來只有50歲,他也挺樂的。
原文參照: http://well.blogs.nytimes.com/2013/08/01/the-limits-of-cosmetic-surgery/
紐約時報中文版翻譯: http://cn.nytimes.com/health/20130805/c05cosmeticsurgery/zh-hant/
2015-10-06.聯合報.D2.健康.編譯彭淮棟