Implications of Aging in Plastic Surgery

Danny S. Roh, MD, PhD; Adriana C. Panayi, MD; Shalender Bhasin, MD; Dennis P. Orgill, MD, PhD; Indranil Sinha, MD


Plast Reconstr Surg Glob Open. 2019;7(1):e2085 

In This Article

Abstract and Introduction


Given the rapidly aging population, investigating the effect of age on plastic surgery outcomes is imperative. Despite this, the topic has received relatively little attention. Furthermore, there appears to be little integration between the basic scientists investigating the mechanisms of aging and the plastic surgeons providing the majority of "antiaging" therapies. This review first provides a description of the effects and mechanisms of aging in 5 types of tissue: skin, adipose tissue, muscles, bones and tendons, and nervous tissue followed by an overview of the basic mechanisms underlying aging, presenting the currently proposed cellular and molecular theories. Finally, the impact of aging, as well as frailty, on plastic surgery outcomes is explored by focusing on 5 different topics: general wound healing and repair of cutaneous tissue, reconstruction of soft tissue, healing of bones and tendons, healing of peripheral nerves, and microsurgical reconstruction. We find mixed reports on the effect of aging or frailty on outcomes in plastic surgery, which we hypothesize to be due to exclusion of aged and frail patients from surgery as well as due to outcomes that reported no postsurgical issues with aged patients. As plastic surgeons continue to interact more with the growing elderly population, a better appreciation of the underlying mechanisms and outcomes related to aging and a clear distinction between chronological age and frailty can promote better selection of patients, offering appropriate patients surgery to improve an aged appearance, and declining interventions in inappropriate patients.


The United States Census Bureau estimates the population >65 years will be 88.5 million by 2050, a 105% increase from 2015.[1] Despite this expanding demographic, the comprehensive effect of age on plastic surgical outcomes and postoperative rehabilitation has received little attention. As new research on aging mechanisms and novel therapies expand, there will need to be increased awareness within the plastic surgery community. As plastic surgeons encounter this growing aged population more, familiarity of basic mechanisms of aging combined with recognition of age impacts on surgical outcomes and rehabilitation becomes essential. This knowledge will help plastic surgeons to continue to obtain consistent results in a predictable manner and avoid morbidity and mortality in our growing elderly population.