Perceived Age Reduction After Rhytidoplasty: A Randomized Clinical Trial Comparing Three Surgical Techniques Using Human and AI Assessment

Perceived age is an objective surrogate for facial rejuvenation, but comparative evidence across facelift techniques using human and AI raters is limited.This trial assessed whether facelift techniques differ in rejuvenation effect and whether AI estimates align with human evaluations.Randomized clinical trial.A total of 30 women (45-65 years) underwent rhytidectomy by deep plane, high SMAS, or plication (<i>n</i> = 10 each). Standardized photographs were rated by 200 laypersons (9,000 evaluations) and three AI models (180 evaluations). Primary outcome was change in perceived age (Δ age); secondary analyses included technique comparison, AI accuracy, rater bias, and human-AI correlation.All techniques significantly reduced perceived age, with no statistical difference between groups. Amazon Rekognition and HowOldDoYouLook were more accurate. Human-AI correlation was moderate (r = 0.41, <i>p</i> = 0.020). Raters under 30 underestimated age (<i>p</i> < 0.001).Human and AI evaluations showed no technique differences, with AI estimates resembling human assessments.