To evaluate the efficacies of four different surgical techniques in facial rejuvenation, two sets of identical twins were operated on by four different surgeons. The technical approaches to facial rejuvenation included lateral superficial musculoaponeurotic system (SMAS)-ectomy with extensive skin undermining, composite rhytidectomy, SMAS-platysma flap with bidirectional lift, and endoscopic midface lift with an open anterior platysmaplasty. All patients were photographed by an independent surgeon at 1, 6, and 10 years postoperatively. At the same time interval, the cases were presented and discussed in a panel format at the annual meeting of the American Society for Aesthetic Plastic Surgery. Each operating surgeon was allowed to critique the results and discuss how his methods had changed over the intervening 10-year interval. Postoperative photographs at 1, 6, and 10 years after surgery are included to allow the reader to examine long-term results utilizing various approaches to facial rejuvenation in identical twins.