Abstract This represents the largest series of face lifts in the World on identical twins. Eight sets of identical twins underwent face lift surgery with a comparison of SMAS techniques. Blood tests were done to ensure that the individuals were indeed identical, rather than fraternal twins and the surgery was always performed the same day, in birth order. Comparisons were made between SMASectomy versus SMAS plication compared to no treatment of the SMAS in selected cases. In all cases, the short term results of more aggressive SMAS treatment led to more swelling, discomfort, and bruising with a tighter appearing short term appearance. However, the long term results were indistinguishable between the various groups. While there are individuals who clearly need and benefit from aggressive work on the SMAS, there is building support for more conservative operations. This paper will explore the logic for conservativism
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