Nobody but nobody wants a turkey neck, but eventually all of us will develop one — unless, of course, we make a special trip to the plastic surgeon. Those who choose to visit an operating room would be wise to consider some impressive new research on facelifts. To prevent a wattle from developing years after the lift, plastic surgeon Darrick Antell and his colleagues suggest patients insist on the full-incision surgical technique rather than the short-scar method.

This is impressive. (We hear you scoff, dear reader.) What makes this study remarkable is this: not only did Antell perform a head-to-head (no pun intended) comparison of the two most popular incision techniques but he did so on four sets of identical twins and one set of identical triplets.

Comparison of surgical techniques Courtesy of Darrick E. Antell, M.D

Hundreds of Thousands

Each year plastic surgeons perform roughly 128,000 facelifts in the United States, the American Society of Plastic Surgeons notes. In his brief history of the facelift, Dr. Paul Howard said that the first published facelift operation was performed by a German surgeon in 1901, but it is doubtful this was the true first since just a few years later, an American physician wrote an entire text book describing his surgical treatments of “featural imperfections.” Dr. Charles Conrad Miller documented corrections made to Crow’s feet, eyelids, thick and thin lips, protruding ears, and other features, all while insisting other practitioners should be specifically trained to perform these complex surgeries.

Forging ahead, Howard said a “quantum leap” in surgical expertise occurred when thousands of civilians and warriors returning home from the first World War required it. In fact, due to his many repairs of facial injuries following the Great War, Sir Harold Gillies of England emerged as the leading plastic surgeon of his generation. However, his claim to fame was short-lived. In 1923, Dr. Henry Schireson performed a nose job on Fanny Brice, the famous Ziegfeld Follies star, and shot into the stratosphere of celebrity.

Once again, following the second World War, plastic surgery experienced a rebirth, and the facelift in particular began to evolve. A notable breakthrough occurred in the 1960s when T. Skoog from Sweden wrote about integrating deeper tissues into this procedure, and shortly thereafter, Dr. D. Ralph Millard described his removal of fat from the neck. And so the basic lift evolved, as surgeons augmented it with liposuction, eyelifts, and other nips and tucks, and the surgical techniques became more refined.

One such refinement popularized in the early 2000s is the short-scar method, which is meant to replace the long-incision technique. While some surgeons argue in favor of the long incision, others insist the short incision is superior, plus it speeds recovery time. What, though, is the truth?

Bring in the Genetic Identicals!

To compare the two incisions, Antell and a team of colleagues performed facelifts on four sets of identical twins and one set of identical triplets between January and August 2006, with participants ranging in age from 56 to 73. One set of twins was male, all other participants were female. Short-term post-operative photos were snapped at the one-year mark, and five years later, longer-term photos were taken.

Next, eight board-certified plastic surgeons with more than 100 years of combined experience graded the photos. Asked to evaluate each patient's jawline, neck, and nasolabial folds — the folds of skin running from the sides of the nose to the corners of the mouth — these judges had no idea which patients had received which facelift. Compiling the scores, Antell and his co-researchers averaged the grades for each region of the face.

What did the team discover? The scores matched at the one-year follow-up, but five years later, one of the techniques rose to the top. While the nasolabial fold and jawline regions were about the same, Antell and his co-authors calculated a significant difference in average scores for the neck region, with the full-incision technique receiving higher marks.

Sure, the sample size of this study was small and the time period relatively short. Still, the results of this unique study make a point. Those wanting to avoid turkey neck and willing to undergo the knife should take heed: the long incision is best.

Source: Antell DE, May JM, Bonnano MJ, Lee NY. A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins. Plastic and Reconstructive Surgery. 2016.