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Safety of Rhytidectomy in the Elderly
Esteban Marten, M.D., M.P.H.1, Claude J. Langevin, D.M.D, M.D.2, Sumesh Kaswan, M.D.3, James E. Zins, M.D.1.
1Cleveland Clinic, Cleveland, OH, USA, 2MD Anderson Cancer Center Orlando, Orlando, FL, USA, 3University of Rochester, Rochester, NY, USA.
The purpose of our study was to evaluate the safety of facelift surgery in an elderly population. Specifically, is chronologic age an independent risk factor leading to a higher complication rate in the elderly patient undergoing rhytidectomy surgery?
We retrospectively reviewed consecutive facelifts (216 patients) performed by a single surgeon at our institution over a three-year period. Patients were then divided into two groups, under age 65 (148 patients) and age 65 and older (68 patients). Co-morbidities, operative details, and complications were compared using statistical analysis.
The average age was 70.0 years in the elderly group and 57.6 years in the younger group. When compared to the patients under age 65, elderly patients were more likely to have a higher ASA score and to have had a prior facelift (41.2% vs. 17.6%, p<0.001, Fisher Exact Test). The elderly underwent just as many extended SMAS dissections (73.5% vs. 83.8%, p=0.077), major adjunctive procedures (69.2% of patients vs. 84.6%, p=0.10) and minor adjunctive procedures (27.9% of patients vs. 28.4%, p=0.58, Cochran-Mantel-Haenszel Exact Test), yet they had slightly shorter operative times.
The elderly had complication rates comparable to those of younger patients (2.9% vs. 2.0% major, p=0.65 and 5.9% vs. 6.1% minor, p=0.99, Fisher Exact Test). However, there were non-significant trends towards higher major complication rates in patients age 70 and older (Relative Risk 2.74, Confidence Interval (0.5, 14.96), p= 0.24) and higher minor complication rates in patients age 75 and older (RR 2.28, CI (0.50, 10.39), p= 0.29, Poisson Regression Model), as well as in ASA 3 patients regardless of age. Complication rates were no different between primary and secondary facelifts, or between extended SMAS and less aggressive facelifts. There were no deaths in either group.
In our series of carefully selected elderly patients age 65 and older, facelift complication rates were not statistically different when compared to a younger control group. Our data suggest that chronologic age alone was not an independent risk factor for facelift surgery. Further studies are needed to define whether a chronologic age limit for safe facelift surgery beyond age 65 exists.
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