Fifteen years ago, a woman came into plastic surgeon Daniel Mills’s office asking for a consult on a face-lift. “She said she was 63 or 64, and this was her second face-lift,” Mills recalls. The day before the surgery, the patient revealed a secret she’d been keeping from her doctor: “Truly, this isn’t my second face-lift; it’s my fourth,” Mills says she told him.
Actually, make that two secrets: “And I’m not 64, I’m 74.”
But this second piece of news wasn’t the shock the patient may have imagined it to be. Mills, currently the president of the American Society for Aesthetic Plastic Surgery, already had an inkling, based on the woman’s skin and hands, that she might have been older than she claimed. Using a person’s appearance to determine their age is a skill that comes with the territory for plastic surgeons — “Obviously, it’s our business, so we should be pretty good at it,” Mills says — but new research shows just how finely honed that skill can be: In a study published last week in JAMA Facial Plastic Surgery, plastic surgeons could estimate a person’s age, accurate to within ten months, by just looking at a photo.
The small study involved seven plastic surgeons with an average of 9.4 years’ experience in the discipline, each of whom viewed 70 different portraits on a computer screen and guessed the subject’s age. The subjects of the photos, who ranged in age from 10 to 70, all had a normal body weight, no history of plastic surgery, and no Botox, fillers, or laser treatments or chemical peels within the last 12 months.
For each photo, the researchers averaged the guesses of all seven surgeons; next, they randomly selected three of the surgeons, averaged their guesses, and compared that to the previous number. The two results were similar enough, the researchers concluded, that just three doctors would yield the same result as a larger group.
And surpassing the researchers’ expectations, that result was an extremely accurate read on a person’s age. “It was amazing for us,” says lead author Denis Souto Valente, a practicing plastic surgeon and resident at Pontifícia Universidade Católica do Rio Grande do Sul in Brazil. He says he previously thought the plastic surgeons might, at their best, have been able to guess ages within two to four years.
It’s not just a party trick. In the paper, Valente and his colleagues wrote that based on their findings, a panel of three surgeons could use their abilities as an “evaluative measure” of cosmetic procedures — in other words, how much did that face-lift actually affect a patient’s perceived age? While the authors admitted that the study’s sample size was small, and that the method relies on the subjectivity of plastic surgeons, they also argued that despite these factors, the study provides some evidence that trained plastic surgeons can accurately evaluate age on sight.
To do so, they rely largely on predictable changes in facial features that occur as people age. In the 40s, the study notes, lines from the corner of the mouth down to the chin start to deepen, and laugh lines begin to appear. These become more pronounced into the 50s, where wrinkles in the neck start to deepen as well. Finally, in the 60s, pockets of fat in the mid-face begin to descend, causing sagging and pronounced lines.
That’s not to say that reversing any one of these processes will necessarily make a person look younger again. According to Kevin H. Small, an assistant professor of plastic surgery at Weill Cornell Medicine, one important factor that patients often neglect to consider is the “global harmony” of their face. For instance, patients may come in asking for an eye-lift, hoping that the procedure will be less invasive and require less recovery time than a face-lift. However, that may result in “discontinuity” with the rest of the face, Small says. And there are other factors that can make a person age prematurely, like sun exposure or smoking. (On the other end of the spectrum, Small says, overweight patients often look younger than they actually are — as we age, the fat in our cheeks starts to descend, changing the face from an egg to a square shape, but extra fat on the face can mask these changes.)
Mills, who wasn’t affiliated with the study, notes that the authors also did not address the controlled lighting of the photographs, which can significantly affect perception of age. “All you have to do is pick up a rag magazine that has before-and-after pictures,” Mills said, “and you can see that the before’s are much darker than the after’s. They use a lot more light, which blanches out all of the little wrinkles.”
So can a plastic surgeon truly guess your exact age from a photo? They can probably get pretty close — but that doesn’t mean a little sunscreen and good lighting won’t work in your favor .