For Doctors in a Hurry
- Surgeons lack sufficient data regarding whether advancing age, particularly beyond 75 years, increases complication risks following rhytidectomy (facelift surgery).
- This retrospective study analyzed 541 consecutive patients undergoing primary or secondary facelifts over a ten year period by one surgeon.
- Major complications occurred in 0.4 percent of patients, while minor events showed no significant association with age (p=0.4).
- The researchers concluded that chronological age is not an independent predictor of adverse events, even for patients older than 75.
- Clinicians may offer facelift surgery to older adults provided they implement strict preoperative screening and standardized postoperative management protocols.
Risk Stratification in the Aging Rhytidectomy Patient
Rhytidectomy remains a primary intervention for facial aging, yet the procedure carries inherent risks such as hematoma, which is the most frequent early complication leading to morbidity [1, 2]. To mitigate these risks, surgeons often employ adjuncts like tranexamic acid (an antifibrinolytic agent used to reduce perioperative bleeding) or hemostatic nets designed to eliminate dead space [3, 4]. While technical choices between deep plane dissections and plication of the superficial musculoaponeurotic system (SMAS, the continuous fibromuscular layer covering deeper facial structures) can influence recovery, patient-specific factors remain critical to the safety profile [5, 6]. As the population of older adults seeking surgical rejuvenation grows, clinicians must determine if advanced age itself necessitates more conservative management. To clarify whether birth year should dictate surgical candidacy, researchers recently evaluated the relationship between advancing age and postoperative complications in a large surgical cohort.
Cohort Characteristics and Age Stratification
The researchers conducted a retrospective review of 10 years of consecutive primary or secondary facelifts performed by a single surgeon, updating a prior 2011 series regarding age-stratified risk in rhytidectomy. This longitudinal analysis included a total of 541 patients who underwent either an extended SMAS dissection or SMAS plication (a technique where the fibromuscular layer is folded and sutured to itself to tighten the facial architecture without excising tissue). To ensure a comprehensive risk profile, the study recorded detailed demographics, comorbidities, and operative details for every patient. To evaluate the impact of aging on surgical outcomes, the researchers analyzed the patient population across five distinct age strata. The distribution of the 541 patients was as follows: 28% were less than 60 years of age, 24% were between 60 and 65, 24% were between 66 and 70, 17% were between 71 and 75, and 7% were 76 years of age or older. By categorizing the cohort into these specific intervals, the study aimed to identify whether a chronological threshold exists where the incidence of major or minor complications begins to rise significantly, providing clinicians with data to better counsel older patients during preoperative consultations.
Surgical Protocol and Complication Definitions
All procedures were performed within a framework of strict preoperative screening and standardized management protocols, which the authors suggest are critical for maintaining safety in an aging population. By utilizing consistent surgical and perioperative methods, the researchers sought to isolate chronological age as a potential risk factor across the cohort. To provide a clear clinical assessment of safety, the researchers categorized adverse events into two tiers based on the level of intervention required. Major complications were strictly defined as those resulting in an unplanned hospital admission, a reoperation, or a persistent motor nerve injury. These severe events were exceptionally rare, occurring in only 0.4% of the total study population, and the incidence did not differ significantly across the five age strata (p=0.08). Adverse events that were managed entirely in an outpatient setting were classified as minor complications. These occurred in 7.6% of patients and showed no significant association with age on univariate analysis (p=0.4) or multivariable analysis. When focusing specifically on the oldest subgroup, the researchers found that being age 76 or older was not associated with an increased risk of any complication, major or minor, after adjusting for comorbidities. This was evidenced by an odds ratio of 1.82 (95% CI, 0.51 to 5.19; p=0.3). For the practicing plastic surgeon or referring primary care physician, these data suggest that the most serious surgical risks do not inherently escalate simply because a patient has passed their 75th birthday.
Safety Outcomes Across Age Thresholds
To ensure a robust analysis of safety outcomes, the researchers evaluated age at specific dichotomous cutoffs (statistical thresholds where the population is divided into two distinct groups) of 66 years or greater, 71 years or greater, and 76 years or greater. They utilized multivariable logistic regression, a statistical method that predicts a clinical outcome while controlling for the influence of multiple overlapping variables, to evaluate the associations between age and postoperative complications. The data consistently revealed that major complications were rare, occurring in only 0.4% of the total patient population, and did not differ significantly by age (p=0.08). Similarly, minor complications occurred in 7.6% of patients and showed no significant association with age on univariate analysis (p=0.4). This lack of association persisted during multivariable analysis, confirming that age did not drive the rate of outpatient-managed adverse events. A detailed subanalysis further demonstrated that age was not associated with any complication, whether major or minor, after adjustment for other clinical factors. For the specific cohort of patients older than 75, the odds ratio for complications was 1.82 (95% CI, 0.51 to 5.19; p=0.3), a result that failed to reach statistical significance. These findings indicate that facelift surgery remained safe across all age groups, including those older than 75 years. Ultimately, the study concludes that chronological age alone is not an independent predictor of adverse events after rhytidectomy. For clinicians, this means that physiological fitness, medical optimization, and rigorous preoperative screening are far more relevant indicators of surgical candidacy than the patient's birth year.
References
1. Caimi E, Pellicanò F, Choueiri JE, et al. Hemostatic Nets in Facelifts: A Systematic Review and Meta-Analysis of Postoperative Complications and Patient Outcomes. Aesthetic Surgery Journal Open Forum. 2025. doi:10.1093/asjof/ojaf082
2. Azzi J, Hadian A, Zabihi-Pour D, et al. Prevention of Hematoma in Patients Undergoing Facelift (Rhytidectomy): A Systematic Review and Meta-Analysis.. Facial Plastic Surgery & Aesthetic Medicine. 2025. doi:10.1177/26893614251393166
3. Prabhughate A, Bellani D, Shome D, Kapoor R, Parkar S, Shahare R. Impact of tranexamic acid on postoperative complications and bleeding in facial aesthetic surgery: A systematic review and meta-analysis.. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2025. doi:10.1016/j.bjps.2025.05.024
4. Alenazi A, Obeid AA, Alderaywsh A, et al. Impact of Tranexamic Acid on Bleeding Outcomes and Complication Rates in Facelift: A Systematic Review and Meta-analysis.. Aesthetic surgery journal. 2024. doi:10.1093/asj/sjae156
5. Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthetic Surgery Journal. 2019. doi:10.1093/asj/sjz045
6. Mortada H, Alkilani N, Halawani IR, et al. Evolution of Superficial Muscular Aponeurotic System Facelift Techniques: A Comprehensive Systematic Review of Complications and Outcomes. JPRAS Open. 2023. doi:10.1016/j.jpra.2023.06.003
