‘I Wasn’t Able to Even Open My Eyes. That’s How Swollen I Was’

Amanda Preisinger feels anxious about her daughter’s upcoming 13th birthday celebration. Not for the typical causes associated with a home packed of clamorous preteen kids, but because it’s the first time she will showcase her new face to acquaintances and extended family. “Obviously I’m going to inform all guests as they come in, ‘Just so you know, this is not the way I look,’” says the 30-year-old real estate agent from south Florida.

How she looks is, well, a somewhat startling – her face puffed up and unnaturally tightened, as though secured by industrial-grade tape. Her new – and she’s eager to emphasize, temporary – appearance is the result of six aesthetic surgeries, including an endoscopic mid-facelift, performed by a doctor in Istanbul, Turkey, the previous month. “My poor husband became emotional when he saw me for the initial time because I couldn’t even unseal my eyes. That’s how puffy I was,” she explains to me via video call from her house. “I had to tell him: ‘Babe, I’m fine, I’m not hurting. I just appear as if someone attacked me.’”

Growing Trend of Early Facelifts

According to cosmetic specialists, Preisinger is among a growing number of people choosing to have a rhytidectomy in their twenties and thirties – significantly before a decade before most doctors’ usual candidate age of 40 to 60. (Although many specialists are keen to emphasise the industry edict of: “We treat genetics, not age.”) “I have individuals in their late twenties requesting facelifts,” says London-based aesthetic plastic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the head and neck. “It’s a major surgery, and I’m a somewhat worried when I observe people opting for it as a lifestyle choice.”

Understanding the Rhytidectomy Surgery

A facelift, alternatively called a rhytidectomy, elevates the ligaments in the face that start to sag as we age. “Our faces are built a bit like layers of an onion,” explains Kent-based face specialist Marc Pacifico. “Skin and fat on the top, then a stratum of supportive tissue called the superficial musculoaponeurotic system. Consider the SMAS as the structural foundation of the face. And that’s what causes aging; that’s what becomes lax and pulls the dermis downward with it.”

You endanger performing surgery on individuals that have underlying problems. It’s not a practice for an ethical plastic surgeon to pursue

Previously reserved of affluent seniors, “filler fatigue” – when excessive use of dermal fillers expands the face and causes laxity in the skin – alongside the widespread use of weight-loss drugs, cut-price medical tourism, and the development of new, famous-figure-promoted surgical techniques are driving a new kind of patient towards this invasive surgery. Reports indicate an 8% increase in facial lifts over the last year in the UK; while a survey revealed that the percentage of youthful candidates is increasing, with 32% of facelifts now performed on patients aged 35-55.

“People are now requesting to appear as the optimal form of themselves and naturally the techniques are evolving,” comments Orfaniotis. Currently, the trending procedure is the comprehensive facial lift, a technique promoted by everyone from reality TV star Kris Jenner, to fashion designer Marc Jacobs.

Deep Plane Technique

Where a more traditional facelift entails elevating the SMAS, the comprehensive lift loosens the facial ligaments beneath it, enabling doctors to restructure the face by repositioning the underlying layers, and avoiding the taut, pulled look sometimes wrought by more traditional techniques. “We avoid placing stress on the dermis because we’re targeting deeper, to the deeper tissue,” explains Harley Street plastic surgeon Rajiv Grover, who focuses on the deep plane technique. “It is the underlying layers that is repositioned. The skin comes with it as a passenger.” Lifting the entire soft tissue layer as a single unit allows for a authentic-appearing and longer-lasting result. It additionally implies that the procedure is no longer being used for the express purpose of youth preservation – or revitalization, as the aesthetics industry terms it – but for “beautification” and facial restructuring, too. “We receive many inquiries from patients aged 28 to 35 for this purpose,” notes Grover.

Individual Experience

Preisinger had not intended on getting a facelift – at least not at the age of 30. But years of using injectable gels in an effort at “facial balancing” meant that by the time she reached her late 20s, she was “damaged”. “I didn’t undergo this because I desired to appear young,” she says. “I underwent it because the filler ruined my face. I regret ever done it. If I didn’t have the injectable, I don’t think I would be in this situation currently.”

Whether injectable substances ever fully dissolve has long been a debated topic in the aesthetics industry. “Research have indicated that they seldom completely dissolve,” states Grover, “but they migrate and can block drainage pathways. A contributing factor to what we call ‘pillow face’ is also the reality that in a sense, the face becomes slightly waterlogged because its capacity to remove lymphatic fluid has been diminished.” Although studies into the topic is early-stage, warnings on injectables’ possible effects on the lymphatic system have been released, and additional studies initiated. One highly regarded face specialist, speaking anonymously, mentioned he would avoid using injectables in a client because of the risks they present. “Many doctors avoid talk about this, because the companies who produce injectables can be quite forceful.” He’s heard stories, he adds, of cosmetic doctors facing legal actions after expressing worries.

Decision and Procedure

For Preisinger, once she started using injectables, she believed she had to keep adding more – especially as it began moving to other parts of her face. She was only twenty-eight when a local plastic surgeon in the state proposed that a facial and neck surgery might be what she required to exit the cycle of treatments. After 24 months, she found herself selecting from a selection of recommended hotels in Istanbul, texted to her by the patient coordinator at her doctor’s clinic.

Initially, Preisinger had scheduled an eyelid surgery – commonly called blepharoplasty – but her doctor recommended that a facelift was the right solution for the laxity she was finding in her face. She booked a brow lift, a cheek lift and a neck lift. The day before her operation, one day after she’d touched down alone in Turkey, she opted to include a lip lift. “Then he stated, ‘We will lift the under-eye bags.’ Then he said, ‘I believe if we remove some buccal fat, it will contour your face.’ Thus I ultimately adding two more surgeries,” she says. She spent $22,000 (£16,500) for the half-day surgery, including a three-day|