Roh Danny S, Panayi Adriana C, Bhasin Shalender, Orgill Dennis P, Sinha Indranil
Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.
Division of Endocrinology, Brigham and Women's Hospital, Boston, Mass.
Plast Reconstr Surg Glob Open. 2019 Jan 14;7(1):e2085. doi: 10.1097/GOX.0000000000002085. eCollection 2019 Jan.
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.
鉴于人口迅速老龄化，研究年龄对整形手术效果的影响势在必行。尽管如此，该话题受到的关注相对较少。此外，研究衰老机制的基础科学家与提供大多数“抗衰”疗法的整形外科医生之间似乎缺乏整合。本综述首先描述了衰老在5种组织中的影响和机制：皮肤、脂肪组织、肌肉、骨骼和肌腱以及神经组织，接着概述衰老的基本机制，介绍当前提出的细胞和分子理论。最后，通过关注5个不同主题来探讨衰老以及身体虚弱对整形手术效果的影响：皮肤组织的一般伤口愈合和修复、软组织重建、骨骼和肌腱愈合、周围神经愈合以及显微外科重建。我们发现关于衰老或身体虚弱对整形手术效果影响的报道不一，我们推测这是由于手术中排除了老年和体弱患者，以及报道老年患者术后无问题的结果。随着整形外科医生与不断增加的老年人群体的互动不断增多，更好地理解与衰老相关的潜在机制和结果，以及明确区分实际年龄和身体虚弱程度，有助于更好地选择患者，为合适的患者提供手术以改善老年容貌，并拒绝为不合适的患者进行干预。
