Harvard built a model that reads biological age from a selfie and predicts who survives cancer treatment. The Lancet Digital Health, this week; the Boston Globe has the numbers; three to ten selfies at faceage.bwh.harvard.edu gets you one.
I have read faces for a living for nearly twenty years. The machine and I agree.
What the Model Found
More than 40 million training faces. About 38,000 patients. Look five years older than your age: 21 percent higher risk of death, adjusted for age, sex and cancer type. Where it looks: the folds beside the nose, the forehead, the temples. Smokers read oldest. Makeup, lighting, pose: nothing. Most plastic surgery: nothing.
The Temples
“The biggest surprise patients see is the change in their face. The face doesn’t have a lot of fat, but the fat it does have is the good fat, the baby fat, what makes you look young. In the face you see the loss of the fat under the eyes, the temporal areas, temporal wasting, the buccal fat. We see the face just melt down because it’s lost all that volume. That’s usually the first thing they notice in the early stages of the weight loss.”
“I think fat grafting has been rising for many years. It’s an essential component of almost all facial procedures. I incorporate fat grafting into lower eyelid surgery, I incorporate it into all my facelifts, and I incorporate it in any facial procedure where the patient has lost a considerable amount of weight. So the GLP-1 wave has certainly increased the demand, but just normal aging is comprised of loss of fat and volume in the face, as well as skin laxity and quality.”
The model stares at the temples. So do I.
The Skin
“If you compare the two time frames and look at the brows, they sit in the same position. They have not been lifted. The excess upper eyelid skin remains. The volume of the cheeks is still in the same place, and the jawline is still sharp. If you look at other photos around the March timeline, it almost seems like she had lost too much weight, and that may have helped make her appear older. In the latest photos, it seems like she gained some of that weight back, which of course fills the face and makes it look younger.”
My Kristen Wiig read, last week. Skin and volume, not surgery.
“We’re having less fat consumption, and fat is an emollient that helps with barriers in the cell membranes. We’re taking less protein, which generates collagen. And we’re usually taking a lot less fluid, so we’re dehydrated. All three decrease the moisture in the skin, which makes it look older a lot quicker. The topicals have two functions: barrier and attracting moisture, and then the antioxidants, which keep the skin looking younger, and retinoids, which can speed up turnover.”
The Cigarette
“Any type of nicotine is the same, and this is something patients don’t realize. They think that because we say smoking, we just want them to stop smoking. But any other form, like Zyn or dip or vaping, the patches and the gum, they all have nicotine. They have the same effect, which is they constrict the small capillaries that carry the nutrients and the growth factors and cells to the scar area to repair and heal.”
“If I know a patient is smoking, I will refuse to do most procedures, but especially any facelift or neck lift, any breast lift or breast reduction, and tummy tucks. All these procedures rely on flaps and capillary blood flow.”
Clamp the capillaries for twenty years and the skin shows it. Nicotine and surgery has the rule.
What Surgery Resets, and What It Does Not
“The most interesting thing about a face lift procedure is that it can make you look ten to fifteen years younger. Of course, that depends on the age at which you get the procedure. If you get it at forty, you’re probably going to look like you’re in your early thirties, or even late twenties. But time keeps moving forward, so if we repeat the procedure ten years later, we take you back to that earlier stage of yourself. Now you’re in your fifties, looking like you’re in your thirties.”
“The reason we’re seeing this increase exponentially is that patients are noticing signs of facial aging earlier, or they’ve been on GLP-1s and have had accelerated aging from fat loss in the face and skin sagging.”
“Preferably I want the patient to have lost the weight that they had planned and be weight stable after any facelift procedure. The reason being that oftentimes patients after a facelift tend to lose further weight. And of course, if we lose the volume, then we will have some aging. As the face deflates, the skin tends to sag.”
Most plastic surgery did not move the number. Not surprised. A lift moves tissue back. The model reads what the tissue is made of: fat in the temples, collagen in the skin, the blood a cigarette shut off. Fat grafting, skin care, no nicotine. The lift alone leaves those alone.
I can make you look younger. I cannot make you be younger. The photo knows the difference now.
Longer reads: face after weight loss, where the cream stops, mother or daughter. Surgical version: agulloplasticsurgery.com. Skin version: the Southwest Plastic Surgery post.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. Fat grafting is part of every facelift he performs.
Ready to Talk?
Upload the selfies if you like. Then bring the number to me and we will talk about which part of it is volume, which part is skin, and which part is a habit.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.