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

Amanda Preisinger experiences worry about her daughter’s upcoming 13th birthday party. Not for the usual causes related to a home packed of clamorous adolescent kids, but because it’s the initial occasion she will debut her recently altered face to acquaintances and relatives. “Obviously I’m going to tell everyone as they arrive, ‘Just so you know, this is not the way I look,’” says the thirty-year-old property agent from Southern Florida.

How she looks is, well, a little startling – her face puffed up and preternaturally lifted, as though secured by industrial-grade tape. Her altered – and she’s keen to stress, short-term – appearance is the outcome of six aesthetic surgeries, such as an endoscopic mid-facelift, performed by a surgeon in Istanbul, Turkey, the previous month. “My poor husband became emotional when he saw me for the initial time because I wasn’t able to even open my eyes. That’s how puffy I was,” she tells me via video call from her house. “I had to tell him: ‘Babe, I’m fine, I’m not in pain. I just appear as if someone attacked me.’”

Increasing Popularity of Early Facelifts

Based on plastic surgeons, Preisinger is among a rising count of individuals 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. (Though most surgeons are eager to highlight the professional guideline of: “We address heredity, not age.”) “I have individuals in their late twenties requesting facelifts,” says London-based cosmetic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the head and neck. “It’s a very significant procedure, and I’m a bit concerned when I see people choosing it as a lifestyle choice.”

Explaining the Facelift Procedure

A facelift, also known as a rhytidectomy, lifts the ligaments in the face that start to sag as we grow older. “Our faces are built a bit like onion layers,” explains Kent-based facial plastic surgeon Marc Pacifico. “Dermis and adipose on the surface, then a layer of connective tissue called the superficial musculoaponeurotic system. Consider the facial framework as the structural foundation of the face. And that is what ages us; that’s what loosens and sags and drags the dermis downward with it.”

You risk operating on individuals that have underlying problems. It’s not a practice for an conscientious surgeon to pursue

Once the preserve of affluent seniors, “filler fatigue” – when overuse of dermal fillers expands the face and leads to laxity in the dermis – combined with the widespread use of weight-loss drugs, low-cost surgical travel, and the development of novel, celebrity-endorsed operative methods are attracting a different type of customer towards this invasive surgery. Statistics indicate an 8% increase in facelifts over the past 12 months in the UK; while a study found that the percentage of younger facelift patients is growing, with 32% of facelifts now conducted for patients aged 35-55.

“People are asking now to look like the optimal form of themselves and obviously the methods are evolving,” says Orfaniotis. At present, the operation du jour is the deep plane facelift, a technique promoted by everyone from reality TV star Kris Jenner, to fashion designer Marc Jacobs.

Deep Plane Technique

While a more traditional rhytidectomy involves lifting the superficial layer, the deep plane facelift releases the facial ligaments beneath it, enabling doctors to restructure the face by repositioning the deeper tissue, and avoiding the tight, stretched appearance occasionally caused by older methods. “We’re not putting tension on the dermis because we’re targeting deeper, to the underlying structures,” says prestigious London cosmetic doctor Rajiv Grover, who specialises in the advanced method. “It is the underlying layers that is repositioned. The skin comes with it as a passenger.” Elevating the whole facial structure as a single unit results in a more natural-looking and more durable outcome. It also means that the procedure is not just being used for the primary goal of anti-ageing – or revitalization, as the cosmetic field describes it – but for “beautification” and facial restructuring, too. “We’re getting numerous requests from patients aged late twenties to mid-thirties for this purpose,” says Grover.

Personal Journey

Preisinger had never planned on getting a facelift – at least not at the age of 30. But years of using injectable gels in an effort at “facial balancing” implied that by the time she reached her late 20s, she was “botched”. “I didn’t undergo this because I wanted to look young,” she says. “I did it because the injectable harmed my face. I wish I had never done it. If I had avoided the injectable, I don’t think I would be where I’m at currently.”

Whether dermal fillers completely disappear has long been a point of contention in the cosmetic field. “Research have indicated that not only do they rarely fully dissipate,” states Grover, “but they move and can obstruct drainage pathways. One of the contributors to what we term ‘puffy appearance’ is additionally the fact that in a sense, the face becomes slightly fluid-filled because its capacity to remove lymphatic fluid has been diminished.” Although studies into the topic is early-stage, warnings on injectables’ potential impact on the lymphatic system have been issued, and further research initiated. An esteemed face specialist, speaking on the condition of anonymity, mentioned he would never use fillers in a client because of the risks they pose. “A lot of doctors avoid discussing this, because the companies who produce injectables can be quite forceful.” He’s been told accounts, he says, of cosmetic doctors facing court orders after expressing worries.

Choice and Surgery

For Preisinger, once she started using injectables, she believed she had to keep adding more – especially as it started to migrate to different areas of her face. She was just 28 when a nearby cosmetic doctor in Florida suggested that a face and neck lift might be what she needed to exit the cycle of treatments. After 24 months, she found herself selecting from a selection of suggested accommodations in the city, texted to her by the clinic assistant at her doctor’s clinic.

Initially, Preisinger had planned for an upper and lower blepharoplasty – commonly called eyelid surgery – but her doctor advised her that a facial lift was the right solution for the laxity she was experiencing in her face. She booked a forehead lift, a cheek lift and a neck lift. The eve of her surgery, 24 hours post she’d arrived solo in Turkey, she decided to add a mouth enhancement. “Subsequently the surgeon said, ‘We’re going to elevate the lower eyelid puffiness.’ He added, ‘I believe if we remove some buccal fat, it will sculpt your face.’ So I ended up adding two more procedures,” she says. She paid $22,000 (sixteen thousand five hundred pounds) for the six-hour surgery, plus a three-day|