Title: Secondary Rhytidectomy: An age old story?
Authors: Alan Matarasso, MD, Steven G. Wallach, MD, Lisa DiFrancesco, MD, and Marlene Rankin, PhD
Goals/Purpose: Statistics published by ASAPS report a 48% increase in cosmetic procedures for 2000-2001. Patients 35-50 account for 30.2% of all rhytidectomies performed. It stands to reason that many of these patients will undergo secondary rhytidectomy. The purpose of this report is to examine any differences in secondary (or more) rhytidectomy patients from those undergoing a primary rhytidectomy.
Methods/Techniques: A retrospective descriptive research design utilizing the computer cross-filing system of the senior author (AM) was reviewed for secondary rhytidectomy patients. A total of 113 consecutive patients were identified, of which 101 charts were available for review. 98 were female and 3 were male. Ages at the time of surgery range from 40-81 with an average of 60. The vast majority underwent a skin facelift with SMAS plication. The patients were divided according to age and the aforementioned issues were evaluated.
Results/Complications: 97 patients underwent their second facelift, and 4 underwent their third. Secondary facelift patients were segregated by age into two groups; Group 1 consisted of 48 patients 60 years of age and Group 2 consisted of 53 patients >60 years of age. Of the 101 patients, 41/53(77%) of Group 2 had combined procedures with their most recent facelift and of these same patients 39/53(74%) had at least one comorbid medical condition defined as hypertension, diabetes, obesity, heart disease, etc. There were a total of 67 additional procedures performed in this group of 53 patients or 1.3 additional procedures/patient. 37/48(77%) of Group 1 patients underwent multiple procedures along with their most recent facelift and 16/48 (33%) had at least one comorbid medical condition. This same group had a total of 70 additional procedures or 1.5 additional procedures/patient. Interestingly, for Group 2, the majority had their most recent facelift more than 10 years after their last one, while for Group 1 the average was less than 10 years. There were two major complications both in Group 1, one consisted of a DVT/PE and the other had a cellulitis. The major complication rate was 2/101(2%).
Conclusion: With advancing age there is a statistically significant increase in the number of comorbid medical conditions. Interestingly, the overall complication rate in the secondary rhytidectomy patients compares favorably to that traditionally quoted for primaries, who on average, are younger at the time of surgery. Nevertheless, these secondary rhytidectomy patients still underwent additional procedures that did not lead to an increase rate of complications. This suggests that in properly screened patients secondary facelifting even in older patients with combined ancillary procedures is both common and safe.