Validation of a Method for Estimation of Facial Age by Plastic Surgeons

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Within cosmetic facial plastic surgery, there is considerable difficulty in producing high-quality scientific publications because of the lack of scientific tools that serve to transform sensations, such as more beautiful or rejuvenated, into numbers capable of being used in statistical analysis.


To validate an objective evaluation method that can be used to define the perception of facial age in scientific studies.

Design, Setting, and Participants

This is a cross-sectional, observational study of evaluation by plastic surgeons of 70 photographs of patients from a private care hospital performed from March 1, 2015, through April 30, 2016. When evaluating the photographs, 7 plastic surgeons wrote down the perceived age of each patient. The photographs of each patient were randomly presented twice to each evaluator (photograph 1 and photograph 2) and analyzed singly using a trimmed mean. Three evaluators were randomly chosen for further statistical analysis in an attempt to make the assessment technique more practical.


Usual aging process.

Main Outcomes and Measures

Estimated mean age and chronological age.


Photographs of 70 patients were evaluated (mean [SD] age, 41.5 [13.8] years; 48 women [68.6%]; and mean [SD] body mass index, 22.5 [2.7]). No significant differences were observed between photographs 1 and 2 for any of the evaluators. A significant difference in the mean ages was not observed when comparing evaluators. For photograph 1 (evaluated by only 3 evaluators), the difference was 0.16 years (P = .52). For photograph 2, the difference was 0.05 years (P = .86). The difference between the mean perceived age for the 3 evaluators and the chronological age was only 0.8 years (<10 months).

Conclusions and Relevance

The intraevaluator and interevaluator agreement suggests that 3 plastic surgeons can estimate the age of a person with a margin of error of 10 months by analyzing a photograph. This article is important to facial plastic surgeons because it reveals how the results of rejuvenation procedures can be assessed.

Level of Evidence


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