Evolving Practices In Rhytidectomy: A 16-year Review Of Continuous Certification Tracer Data From The American Board Of Plastic Surgery
Michael J. Stein, MD, MAS, FRCSC1, Nikhil D. Shah, BS2, John Harrast, MS2, James E. Zins, MD, FACS3, Alan Matarasso, MD, FACS1, Arun K. Gosain, MD, FACS2.
1Lenox Hill Hospital, New York, NY, USA, 2Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA, 3American Board of Plastic Surgery, Chicago, IL, USA.
Purpose: This study evaluates change in practice patterns in rhytidectomy based on a 16-year review of tracer data collected by the American Board of Plastic Surgery as part of the Continuous Certification process.
Methods: Tracer data for rhytidectomy were reviewed from 2006-2021, and data were compared between 2006-2014 and 2015-2021.
Results: Of 3400 facelifts performed, 18% were done in a hospital and 76% in an accredited office facility. In 2015-2021, there were significant increases in the proportion of patients concerned about volume loss/deflation, along with an increased frequency of concomitant fat grafting during rhytidectomy (Table 1). Significantly fewer surgeons utilized postoperative steroids. In the latter cohort, there was an increase in the proportion of secondary facelifts; more surgeons utilized the lateral SMAS flap, and significantly fewer surgeons used an extended SMAS flap and Minimal Access Cranial Suspension (MACS) lift. Hematoma was the most common postoperative complication (3%).
Conclusions: Autologous fat grafting has been shown to restore soft tissue deflation and provide structural support to the face. Rhytidectomy has evolved in the past 16 years with increase in fat grafting and use of the lateral SMAS flap, with decreased steroid use and increased use of static compressive stockings in the cohort from 2015-2021. Secondary facelift is also being done more commonly. Further work is needed to show significant differences in outcomes and longevity between different techniques.
| Item | 2006- 2014 n = 1710 | 2015- 2021 n = 1690 | p |
| Patient Concerns of Volume loss/deflation | 25% | 37% | <0.001* |
| Static compressive stockings | 13% | 20% | <0.001* |
| Postoperative Steroid Use | 30% | 16% | <0.001* |
| Concomitant Fat grafting | 15% | 24% | 0.001* |
| Surgical Technique | |||
| Secondary Facelift | 4% | 18% | <0.001* |
| Lateral SMAS flap | 14% | 18% | 0.002* |
| Extended SMAS flap | 21% | 18% | 0.021* |
| MACS lift | 10% | 6% | <0.001* |
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