Skip to main content

Plastic Surgery in the Elderly

  • Chapter
  • First Online:
Surgical Decision Making in Geriatrics
  • 419 Accesses

Abstract

As the population of the United States continues to age, there is an increasing demand for plastic surgery among the elderly population. The American Society of Plastic Surgeons reported a year to year 2% increase in procedures by patients over the age of 55 to 4.2 million cosmetic procedures in 2018 alone [1]. By 2050, the United States is expected to accelerate its elderly population growth of people 65 or older to 88.5 million people from its current 50 million today [2]. With age, there is an increasing demand for reconstructive surgeries such as wound care, tumor removal, and cancer reconstruction. ASPS statistics reveal a 29% increase in breast reconstruction alone with over 101,000 cases performed in 2018 [1]. The fastest rising trend in plastic surgery is the demand for post-bariatric body lifts with arm and lower truncal lift accounting for 5000% increase in numbers over the past two decades. With a third of Americans obese, there is no doubt these interventions will continue to rise. Furthermore, media and global access drive the celebrity culture and medical tourism which in turn have created a disproportionate demand for “minimally invasive” procedures that have made “60 is the new 40 years of age” culture and have contributed to the $40 billion plastic surgery global market. Therefore it is important to understand the plastic surgery principles surrounding the aging needs of the elderly population as it pertains to economic impact, improved outcomes, and the health of our society.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. ASPS 2018 statistics. Available at www.plasticsurgery.org.

  2. US census bureau US department of commerce 2010.

    Google Scholar 

  3. Okada HC, Alleyne B, Varghai K, Kinder K, Guyuron B. Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins. Plast Reconstr Surg. 2013;132(5):1085–92. If we can get permission we can incorporate this photo as well form this study

    Article  CAS  PubMed  Google Scholar 

  4. Ichibori R, Fujiwara T, Tanigawa T, Kanazawa S, Shingaki K, Torii K, Tomita K, Yano K, Osaka Twin Research Group, Sakai Y, Hosokawa K. Objective assessment of facial skin aging and the associated environmental factors in Japanese monozygotic twins. J Cosmet Dermatol. 2014 Jun;13(2):158–63. https://doi.org/10.1111/jocd.12081.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shaw RB Jr, Katzel EB, Koltz PF, Yaremchuk MJ, Girotto JA, Kahn DM, Langstein HN. Aging of the facial skeleton: aesthetic implications and rejuvenation strategies. Plast Reconstr Surg. 2011;127(1):374–83.

    Article  CAS  PubMed  Google Scholar 

  6. Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg. 2012;36(4):753–60. https://doi.org/10.1007/s00266-012-9904-3 . Epub 2012 May 12.

    Article  Google Scholar 

  7. Shaw RB Jr, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg. 2007;119(2):675–81; discussion 682-3.

    Article  CAS  PubMed  Google Scholar 

  8. Mendelson BC. Anatomic study of the retaining ligaments of the face and applications for facial rejuvenation. Aesthet Plast Surg. 2013;37(3):513–5. https://doi.org/10.1007/s00266-013-0066-8.

    Article  Google Scholar 

  9. El-Domyati M, Attia S, Saleh F, Brown D, Birk E, Gasparro F, Ahmad H, Uitto J. Intrinsic aging vs. photoaging: a comparative histopathological, immunohistochemical, and ultrastructural study of skin:398–405First. Published: 04 October 2002 experimental dermatology

    Google Scholar 

  10. Type I and III collagen content and fibre distribution in normal human skin during ageing C.R. Lovellk.A. Smolenskiv.C. Duancen.D. Lights. Youngm. Dyson First published: October 1987.

    Google Scholar 

  11. Werth VP, Shi X, Kalathil E, Jaworsky C. Elastic fiber-associated proteins of skin in development and photoaging. Photochem Photobiol. 1996;63:308–13.

    Article  CAS  PubMed  Google Scholar 

  12. Watson REB, Griffiths CEM, Craven NM, Shuttleworth CA, Kielty CM. Fibrillin-rich microfibrils are reduced in photoaged skin. Distribution at the dermal-epidermal junction. J Invest Dermatol. 1999;112:782–7.

    Article  CAS  PubMed  Google Scholar 

  13. Yaar M, Gilchrest BA. Photoageing: mechanism, prevention and therapy. Br J Dermatol. 2007;157:874–87.

    Article  CAS  PubMed  Google Scholar 

  14. Farage MA, Miller KW, Elsner P, Maibach HI. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci. 2008;30:87–95.

    Article  CAS  PubMed  Google Scholar 

  15. Varani J, Dame MK, Rittie L, Fligiel SE, Kang S, Fisher GJ, Voorhees JJ. Decreased collagen production in chronologically aged skin: roles of age-dependent alterations in fibroblast function and defective mechanical stimulation. Am J Pathol. 2006;168:1861–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lapiere CM. The ageing dermis: the main cause for the appearance of ‘old’ skin. Br J Dermatol. 1990;122(Suppl. 35):5–1.

    Google Scholar 

  17. Ali S, Garcia JM. Sarcopenia, cachexia and aging: diagnosis, mechanisms and therapeutic options—a mini-review. Gerontology. 2014;60:294–305.

    Article  CAS  PubMed  Google Scholar 

  18. Boros K, Freemont T. Physiology of ageing of the musculoskeletal system. Best Pract Res Clin Rheumatol. 2017;31:203–17.

    Article  PubMed  Google Scholar 

  19. Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci. 2013;68:1236–42.

    Article  PubMed  Google Scholar 

  20. Pannese E. Morphological changes in nerve cells during normal aging. Brain Struct Funct. 2011;216:85–9.

    Article  PubMed  Google Scholar 

  21. Kovacic U, Sketelj J, Bajrović FF. Chapter 26: age-related differences in the reinnervation after peripheral nerve injury. Int Rev Neurobiol. 2009;87:465–82.

    Article  CAS  PubMed  Google Scholar 

  22. Roh DS, Panayi AC, Bhasin S, Orgill DP, Sinha I. Implications of aging in plastic surgery. Plast Reconstr Surg Glob Open. 2019;7(1):e2085. Published online 2019 Jan 14. https://doi.org/10.1097/GOX.0000000000002085.

    Article  Google Scholar 

  23. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27; discussion 2228-31.2008 May;121(5):1804-9.

    Article  CAS  PubMed  Google Scholar 

  24. Rohrich RJ, Pessa JE The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments.

    Google Scholar 

  25. JE P. SMAS fusion zones determine the subfascial and subcutaneous anatomy of the human face: fascial spaces, fat compartments, and models of facial aging. Aesthet Surg J. 2016;36(5):515–26. https://doi.org/10.1093/asj/sjv139. Epub 2016 Feb 23

    Article  Google Scholar 

  26. Foissac R, Camuzard O, Piereschi S. High-resolution magnetic resonance imaging of aging upper face fat compartments. Plast Reconstr Surg. 2017;139(4):829–37.

    Article  CAS  PubMed  Google Scholar 

  27. Vidya R, Berna G, Sbitany H, et al. Prepectoral implant-based breast reconstruction: a joint consensus guide from UK, European and USA breast and plastic reconstructive surgeons. Ecancermedicalscience. 2019;13:927. Published 2019 May 7. https://doi.org/10.3332/ecancer.2019.927.

    Article  Google Scholar 

  28. Knackstedt R, et al. Direct-to-implant breast reconstruction in women older than 65 years. Plast Reconstr Surg. 2018;141(4):1076. https://doi.org/10.1097/prs.0000000000004469.

    Article  Google Scholar 

  29. Torabi R, Stalder MW, Tessler O. Assessing age as a risk factor for complications in autologous breast reconstruction. Plast Reconstr Surg. 2018;142(6):840e–6e.

    Article  CAS  PubMed  Google Scholar 

  30. Santosa KB, Qi J, Kim HM, et al. Effect of patient age on outcomes in breast reconstruction: results from a multicenter prospective study. J Am Coll Surg. 2016;223:745–54.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Retrouvey H, et al. The effect of increasing age on outcomes of digital revascularization or replantation. Plast Reconstr Surg. 2018:1. https://doi.org/10.1097/prs.0000000000005195.

  32. Barzin A, Hernandez-Boussard T, Lee GK, et al. Adverse events following digital replantation in the elderly. J Hand Surg Am. 2011;36:870–4.

    Article  PubMed  Google Scholar 

  33. Kwon GD, Ahn BM, Lee JS, et al. The effect of patient age on the success rate of digital replantation. Plast Reconstr Surg. 2017;139:420–6.

    Article  CAS  PubMed  Google Scholar 

  34. Dy CJ, Daluiski A, Do HT, et al. The epidemiology of reoperation after flexor tendon repair. J Hand Surg Am. 2012;37:919–24.

    Article  PubMed  Google Scholar 

  35. Rigo IZ, Røkkum M. Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3. J Hand Surg Eur. 2016;41:793–801.

    Article  CAS  Google Scholar 

  36. Sosin M, et al. Microsurgical scalp reconstruction in the elderly. Plast Reconstr Surg. 2015;135(3):856–66. https://doi.org/10.1097/prs.0000000000000959.

    Article  CAS  PubMed  Google Scholar 

  37. Üstün GG, Aksu AE, Uzun H, et al. The systematic review and meta-analysis of free flap safety in the elderly patients. Microsurgery. 2017;37:442–50.

    Article  PubMed  Google Scholar 

  38. Jubbal KT, Zavlin D, Suliman A. The effect of age on microsurgical free flap outcomes: an analysis of 5,591 cases. Microsurgery. 2017;8:858–64.

    Article  Google Scholar 

  39. Xiong L, Gazyakan E, Wähmann M, et al. Microsurgical reconstruction for post-traumatic defects of lower leg in the elderly: a comparative study. Injury. 2016;47:2558–64.

    Article  PubMed  Google Scholar 

  40. Bhama PK, Patel SA, Khan U, et al. Head and neck free flap reconstruction in patients older than 80 years. J Reconstr Microsurg. 2014;30:523–30.

    Article  PubMed  Google Scholar 

  41. Goh CS, Kok YO, Yong CP, et al. Outcome predictors in elderly head and neck free flap reconstruction: a retrospective study and systematic review of the current evidence. J Plast Reconstr Aesthet Surg. 2018;71:719–28.

    Article  PubMed  Google Scholar 

  42. Serletti JM, Higgins JP, Moran S, et al. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg. 2000;106:66–70.

    Article  CAS  PubMed  Google Scholar 

  43. Grammatica A, Piazza C, Paderno A, et al. Free flaps in head and neck reconstruction after oncologic surgery: expected outcomes in the elderly. Otolaryngol Head Neck Surg. 2015;152:796–802.

    Article  PubMed  Google Scholar 

  44. Garner Wl. Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians. Yearbook of Plastic and Aesthetic Surgery. 2007;2007:274–5. https://doi.org/10.1016/s1535-1513(08)70243-1.

    Article  Google Scholar 

  45. Chen XF, Chen YM, Gokavarapu S, et al. Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care. Br J Oral Maxillofac Surg. 2017;55:793–7.

    Article  CAS  PubMed  Google Scholar 

  46. Falcone PA, et al. Maxillofacial fractures in the elderly. Plast Reconstr Surg. 1990;86(3):443–8. https://doi.org/10.1097/00006534-199009000-00009.

    Article  CAS  PubMed  Google Scholar 

  47. Atisha DM, Burr TV, Allori AC, et al. Facial fractures in the aging population. Plast Reconstr Surg. 2016;137:587–93.

    Article  CAS  PubMed  Google Scholar 

  48. Mundinger GS, Bellamy JL, Miller DT, et al. Defining population-specific craniofacial fracture patterns and resource use in geriatric patients: a comparative study of blunt craniofacial fractures in geriatric versus nongeriatric adult patients. Plast Reconstr Surg. 2016;137:386e–93e.

    Article  CAS  PubMed  Google Scholar 

  49. Yeslev M, et al. Safety of cosmetic procedures in elderly and octogenarian patients. Aesthet Surg J. 2015;35(7):864–73. https://doi.org/10.1093/asj/sjv053.

    Article  PubMed  Google Scholar 

  50. Gutowski Ka. The safety of Rhytidectomy in the elderly. Yearbook of Plastic and Aesthetic Surgery. 2013;2013:90–1. https://doi.org/10.1016/j.yprs.2011.11.005.

    Article  Google Scholar 

  51. Karamanos E, Osgood G, Siddiqui A, et al. Wound healing in plastic surgery: does age matter? An American College of Surgeons National Surgical Quality Improvement Program study. Plast Reconstr Surg. 2015;135:876–81.

    Article  CAS  PubMed  Google Scholar 

  52. Joslyn NA, et al. Evidence-based strategies for the prehabilitation of the abdominal wall reconstruction patient. Plast Reconstr Surg. 2018;142:21s.

    Article  CAS  PubMed  Google Scholar 

  53. Giordano S, Schaverien M, Garvey PB, et al. Advanced age does not affect abdominal wall reconstruction outcomes using acellular dermal matrix: a comparative study using propensity score analysis. Am J Surg. 2017;213:1046–52.

    Article  PubMed  Google Scholar 

  54. Maklebust J, Magnan MA. Risk factors associated with having a pressure ulcer: a secondary data analysis. Adv Wound Care. 1994;7:25, 27–28, 31.

    Google Scholar 

  55. Margolis DJ, Bilker W, Knauss J, et al. The incidence and prevalence of pressure ulcers among elderly patients in general medical practice. Ann Epidemiol. 2002;12:321–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kaveh Alizadeh .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Alizadeh, K., Elzanie, A. (2020). Plastic Surgery in the Elderly. In: Latifi, R. (eds) Surgical Decision Making in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-47963-3_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47963-3_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47962-6

  • Online ISBN: 978-3-030-47963-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics