Monday April 13 2015
The technical term for a facelift is rhytidoplasty
"Having plastic surgery can make you more likeable," the Mail Online reports. It says cosmetic facial surgery not only makes you look younger, but could also improve what people think of your character. As the Mail Online reports, women who received surgery "were rated as more attractive, feminine, and trustworthy".
This headline is based on a study carried out by plastic surgeons, which asked volunteers to rate the before and after photos of 30 women who had facial plastic surgery to make them look younger.
It found that, on average, the post-surgery photos were rated slightly, but significantly, better for femininity, attractiveness and four personality traits, including likeability (but not trustworthiness).
However, this study has a number of limitations, which means its results are not conclusive. For example, the study was relatively small. The results also may not apply to all people who have had facial surgery, or be in line with the opinions of all people who viewed the before and after results.
In addition, the differences in scores were relatively small – between 0.36 and 0.39 on a seven-point scale. It's unclear whether this would have any real-life impact on people's interaction with the women if they saw them in person. A much larger study is needed to confirm these findings.
Many would argue that resorting to cosmetic surgery to boost your perceived likeability by a small amount is a drastic step. If you are considering plastic surgery, you should think carefully about the reasons why you want it and discuss your plans with your GP first.
Where did the story come from?
The study was carried out by researchers from Georgetown University Hospital and other surgical and research centres in the US.
No sources of funding were reported, and the authors reported no conflicts of interest. However, two of the study authors performed the facial rejuvenation surgeries on the women.
The study was published in the peer-reviewed medical journal, JAMA Facial Plastic Surgery.
The Mail Online does not point out any of this study's limitations. Its headline suggests that perceived trustworthiness was improved after surgery. But this difference was not statistically significant, meaning that we cannot confidently rule out this result occuring by chance.
What kind of research was this?
This was a cross-sectional study looking at whether people's perceptions of women's personalities changed after they had facial rejuvenation surgery.
While this type of plastic surgery is focused on making women look younger, the researchers wanted to see if people also changed their judgements about the women's personalities based on their photos alone.
This study design seems appropriate to the question, though it has many limitations in terms of the way it was applied, including the small sample size.
What did the research involve?
The researchers used before and after photos of 30 white women who had undergone facial rejuvenation surgery. They split these photos into six groups, each with five pre-surgery and five post-surgery photos (not of the same women).
They asked volunteers to rate the photos for their views on the women's femininity, attractiveness and six personality traits. The researchers then assessed how women scored based on their post-surgery compared with their pre-surgery photos.
The women whose photos were used had surgery between 2009 and 2013, including procedures such as:
- eyelid surgery (to remove loose skin above the eyes or bags under the eyes)
- eyebrow lift
- neck lift
- chin implant
To be included, the women's photos had to show well-matched, neutral facial expressions. The women had given permission for their photos to be used for research purposes.
The volunteers who rated the photos online did not know what the aim of the study was. Each set of photos was shown to at least 50 volunteers, and at least 24 responses were received for each set.
The volunteers were asked to rate the women on how much they thought they had the following personality traits on a seven-point scale, ranging from "strongly disagree" to "strongly agree", based on facial photos only:
- social skills
The volunteers were not shown the same woman before and after surgery to avoid comparing them directly. The volunteers did not know the aim of the study.
Doctors, nurses or other healthcare workers with experience of facial analysis or facial plastic surgery were not allowed to take part.
The researchers compared the average scores for the pre- and post-surgery photos for each woman individually and overall. They also assessed the women according to what type of surgery they had.
What were the basic results?
Overall, the researchers found the women's post-surgery photos scored better than their pre-surgery photos on the seven-point scale for:
- likeability – post-surgery photos scored 0.36 points higher on average
- social skills – post-surgery photos scored 0.38 points higher on average
- attractiveness – post-surgery photos scored 0.36 points higher on average
- femininity – post-surgery photos scored 0.39 points higher on average
There were no statistically significant differences in:
When looking at individual surgeries, the only two procedures associated with significant changes in scores were facelift (22 women) and lower eyelid surgery (13 women).
The researchers did not find differences in results by women's age, pre-surgery attractiveness scores, number of surgical procedures, or operating surgeon.
How did the researchers interpret the results?
The researchers concluded that, "Facial plastic surgery changes the perception of patients by those around them."
They say that although the surgery is generally aimed at making people look younger, the study found it also affected people's views on a woman's likeability, social skills, attractiveness, and femininity.
This study suggests that people's perceptions of women's femininity, attractiveness and certain personality traits can improve after they receive facial surgery that aims to make them look younger.
However, there are a number of points to bear in mind:
- The study was relatively small, assessing only 30 women (average age not reported) and only up to 50 people rating each set of photos. The women were also all white and operated on by the same two surgeons. The results may not be applicable to all people who have these kinds of surgeries or to all people viewing the results.
- It was not clear how many women's photos were assessed for inclusion, or whether the person selecting which photos to use knew the purpose of the study. Ideally, they would have been blinded to the purpose of the study so this could not influence their selection, either consciously or subconsciously.
- All patients reportedly had to agree to have their photos used, but it was unclear whether this meant every patient operated on, or just those who had their photos used in the study. If they were asked after surgery, women whose surgeries had a good result may have been more likely to allow their photos to be used.
- Results may depend on how much younger the woman looks or how natural the results look. Ideally, researchers also would have assessed people's perceptions of the women's ages and whether they had facial surgery or looked natural, and how these factors affected personality assessment. In the three "after" photos shown in the research paper, the women look relatively natural, without obvious signs of having had facial surgery.
- The researchers carried out a lot of statistical tests and there is a chance that some of them yielded significant results just by chance.
- It was unclear exactly how many women had each surgery, and therefore whether the analyses by type of surgery had enough "power" to detect differences between the groups. Some women had multiple surgeries, making it difficult to separate their effects.
- The differences seen in the scores were relatively small – between 0.36 and 0.39 on a seven-point scale. It is unclear whether a difference of this size would have any real-life impact on people's interaction with the women, or whether they would express similar views if they saw the women in person.
- The photos shown as examples in the research paper were not identical in terms of what the women were wearing (clothes or make-up) – ideally, these would have been standardised.
Overall, this small study gives some indication that people may judge photographs of women who have had facial surgery differently in terms of attractiveness, femininity and personality, but it is not conclusive. A much larger study is needed to confirm this.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.