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Nonsurgical Facial Rejuvenation Procedures in Patients Under 50 Prior to Undergoing Facelift: Habits, Costs, and Results

By: Andrew A. Jacono, MD, FACS, Melanie H. Malone, MD, Thomas John Lavin, BS Author Notes
Source: Oxford Academic


Facial rejuvenation in patients younger than 50 years of age has experienced an unprecedented growth with multimodality nonsurgical and less invasive rhytidectomy techniques.

To analyze the nonsurgical treatment habits of patients prior to undergoing rhytidectomy at <50 years of age.

Retrospective study to enlist patients who underwent primary rhytidectomy at age <50 years between January 1, 2003 and December 31, 2013 by the senior author (AAJ) to complete a survey.

One hundred and fifty-seven patients were surveyed. Patients had nonsurgical rejuvenation starting at an average age of 37 years and rhytidectomy at an average age of 44 years. Thirty-two percent of responders had injectable treatments prior to their facelift, reporting a mean of 7 rounds of injectable treatments prior to pursuing rhytidectomy. Sixteen percent of responders had laser skin botox tresurfacing undergoing 4 separate treatments prior to rhytidectomy, and 10% had energy-based facial tightening treatments one time prior to their rhytidectomy. Average expenditure on nonsurgical treatments prior to rhytidectomy was $7000 cumulatively. Fifty-nine percent of patients who went on to rhytidectomy did not report regret over this cost expenditure. Patients reported that they appeared 4 years younger after nonsurgical intervention, and 8 years younger after their facelift, a statistically significant difference (P = .048).

Patients undergoing rhytidectomy <50 years old begin less invasive facial rejuvenation treatments at an even earlier age. The majority of these patients did not regret the costs associated with noninvasive treatments, even though they saw that rhytidectomy provided a greater rejuvenation effect. Rhytidectomy surgeons should incorporate nonsurgical techniques into their practice to best serve the needs of the modern aging face patient.


The field of facial rejuvenation has experienced an unprecedented growth with the expanding market of nonsurgical and minimally invasive techniques now available, such as neurotoxins, soft tissue fillers, lasers, and energy-based soft tissue tightening devices (ie, radiofrequency and microfocused ultrasound). As these less invasive options gain notoriety and trust from the public, consumption continues to grow. Since the year 1997 the use of injectables (including Botulinum Toxin A and soft tissue fillers) has grown by 6448%, and laser skin resurfacing by 111%.1 This growth strongly suggests that less invasive options have a much broader catchment amongst the population, possibly attracting patients of a younger age range than more traditional surgical options.

The management of facial rejuvenation has evolved substantially since its inception. Surgery, however, has remained the standard of care for long lasting treatment of the aging face. Despite the growing market of less invasive techniques, rhytidectomy has maintained a stronghold in facial rejuvenation as the number of facelifts performed annually has increased by 28% over the past 18 years as nonsurgical options continue to grow at an exponential rate.1 In fact, rhytidectomy currently ranks as the seventh most common cosmetic surgery performed in the United States, with 127,297 facelifts performed annually.1

Younger women specifically are increasingly seeking intervention for the treatment of facial aging.2 Despite this finding, national surveys have shown a trend of younger patients comprising a smaller proportion of all patients undergoing rhytidectomy in recent years. In 2015, patients <50 years of age comprise 14% of the patients undergoing rhytidectomy, whereas statistics from 2000 show this age group represented 32% of the facelifts performed annually when many modern day nonsurgical options were not available.3

Minimally invasive methods of facial rejuvenation have proven to be effective, and also have won the trust of the public. The field of injectables and lasers will continue to expand as novel techniques and applications emerge. It is of paramount importance to appreciate the role of these techniques in comprehensively treating the aging face, particularly with respect to how these methods interplay with surgical standards of treatment.

This study analyses the characteristics of patients undergoing rhytidectomy under age 50, including their motivation for facial rejuvenation, their utilization of nonsurgical modalities prior to surgery, the types and frequency of nonsurgical treatments they underwent prior to surgery with economic considerations, and their satisfaction/perceived outcomes with their noninvasive and surgical treatments.

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