‘My Eyes Were So Puffy I Couldn’t Even Open Them’

Amanda Preisinger is nervous about her child’s upcoming 13th birthday celebration. Not for the usual reasons associated with a house full of clamorous adolescent kids, but since it’s the initial occasion she will showcase her new face to acquaintances and extended family. “Obviously I’m going to inform everyone as they come in, ‘Just so you know, this is not the way I look,’” says the thirty-year-old real estate agent from Southern Florida.

How she looks is, well, a little surprising – her face puffed up and unnaturally tightened, as though secured by heavy-duty tape. Her altered – and she’s keen to stress, temporary – appearance is the outcome of half a dozen aesthetic surgeries, such as an endoscopic mid-facelift, conducted by a surgeon in Istanbul, Turkey, last month. “My poor husband teared up when he saw me for the initial time because I wasn’t able to even unseal my eyes. That’s how swollen I was,” she explains to me via online call from her home. “I had to tell him: ‘Honey, I’m okay, I’m not in pain. I just look like someone attacked me.’”

Growing Trend of Youthful Facial Lifts

Based on cosmetic specialists, Preisinger is one of a growing number of people choosing to undergo a rhytidectomy in their twenties and thirties – significantly before a ten years before most doctors’ typical patient age range of forty to sixty. (Although many specialists are keen to emphasise the industry edict of: “We treat genetics, not years.”) “I have 28-year-olds asking for facelifts,” says London-based aesthetic plastic surgeon Georgios Orfaniotis, a former NHS consultant who specialises in the head and neck. “It’s a very significant surgery, and I’m a somewhat worried when I see people opting for it as a lifestyle choice.”

Understanding the Facelift Procedure

A facelift, alternatively called a rhytidectomy, elevates the ligaments in the face that start to sag as we age. “Human faces are structured a bit like layers of an onion,” explains based in Kent facial plastic surgeon Marc Pacifico. “Skin and fat on the top, then a stratum of connective tissue called the SMAS. Consider the SMAS as the soft tissue skeleton of the face. And that’s what ages us; that’s what becomes lax and pulls the skin downward with it.”

You risk operating on people that have deeper issues. It’s not advisable for an conscientious surgeon to pursue

Once the preserve of affluent seniors, overuse of injectables – when excessive use of dermal fillers expands the face and causes looseness in the skin – combined with the common adoption of slimming medications, low-cost surgical travel, and the advancement of new, celebrity-endorsed operative methods are attracting a different type of patient towards this major operation. Reports indicate an eight percent rise in facial lifts over the last year in the United Kingdom; while a survey revealed that the percentage of younger facelift patients is increasing, with 32% of facelifts now conducted for individuals aged thirty-five to fifty-five.

“People are now requesting to appear as the best version of themselves and naturally the methods are evolving,” says Orfaniotis. Currently, the operation du jour is the comprehensive facial lift, a technique evangelised by everyone from reality TV star Kris Jenner, to fashion designer Marc Jacobs.

Deep Plane Technique

While a conventional rhytidectomy involves elevating the SMAS, the deep plane facelift loosens the underlying structures beneath it, allowing surgeons to restructure the face by repositioning the deeper tissue, and preventing the tight, stretched appearance sometimes wrought by more traditional techniques. “We avoid placing stress on the skin because we’re going below, to the underlying structures,” says Harley Street plastic surgeon Rajiv Grover, who specialises in the advanced method. “It is the deeper tissue that is adjusted. The dermis follows along as a secondary element.” Lifting the entire soft tissue layer as a single unit results in a more natural-looking and more durable result. It additionally implies that the surgery is no longer being used for the express purpose of youth preservation – or rejuvenation, as the cosmetic field terms it – but for “beautification” and contouring, too. “We receive numerous requests from patients aged late twenties to mid-thirties for this purpose,” says Grover.

Personal Journey

Preisinger had not intended on undergoing a facial lift – at minimum not at the age of 30. But years of using hyaluronic acid dermal fillers in an effort at “symmetry correction” meant that by the time she entered her late twenties, she was “damaged”. “I didn’t undergo this because I wanted to look youthful,” she clarifies. “I underwent it because the filler ruined my face. I regret ever done it. If I had avoided the filler, I don’t believe I would be in this situation right now.”

Whether injectable substances ever fully dissolve has historically been a point of contention in the cosmetic field. “Studies have shown that not only do they rarely completely dissolve,” says Grover, “but they move and can block drainage pathways. One of the contributors to what we term ‘pillow face’ is also the fact that in a sense, the face gets somewhat waterlogged because its ability to drain lymphatic fluid has been diminished.” Although studies into the area is preliminary, cautionary statements on dermal fillers’ potential impact on the body’s drainage have been issued, and additional studies announced. One highly regarded face specialist, commenting anonymously, says he would avoid using injectables in a patient because of the risks they pose. “Many doctors avoid talk about this, because the manufacturers who make injectables can be quite forceful.” He’s heard stories, he says, of cosmetic doctors being landed with legal actions after raising their concerns.

Choice and Surgery

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 nearby cosmetic doctor in the state suggested that a face and neck lift might be what she required to exit the cycle of treatments. After 24 months, she found herself selecting from a list of recommended hotels in the city, texted to her by the clinic assistant at her doctor’s clinic.

Initially, Preisinger had planned for an eyelid surgery – better known as blepharoplasty – but her surgeon advised her that a facial lift was the correct option for the laxity she was experiencing in her face. She booked a forehead lift, a mid-facelift and a jawline surgery. The eve of her operation, 24 hours post she’d touched down alone in Turkey, she opted to include a lip lift. “Subsequently the surgeon said, ‘We’re going to lift the lower eyelid puffiness.’ He added, ‘I think if we remove some buccal fat, it will sculpt your face.’ Thus I ultimately including additional procedures,” she recalls. She spent $22,000 (sixteen thousand five hundred pounds) for the six-hour surgery, including a three-day|