‘I Couldn’t Even Open My Eyes. That’s The Extent of the Swelling I Was’

Amanda Preisinger feels anxious about her child’s upcoming 13th birthday party. Not for the typical reasons associated with a home packed of clamorous preteen kids, but because it’s the first time she will reveal her new face to friends and extended family. “Obviously I’m going to tell everyone as they arrive, ‘Just so you know, this is not how I look,’” states the thirty-year-old real estate agent from south Florida.

Her appearance is, well, a little startling – her face swollen and unnaturally tightened, as though secured by industrial-grade tape. Her new – and she’s eager to emphasize, short-term – look is the outcome of half a dozen cosmetic procedures, such as an endoscopic mid-facelift, performed by a doctor in Turkey’s Istanbul, the previous month. “My poor husband teared up when he saw me for the first time because I couldn’t even open my eyes. That’s how puffy I was,” she tells me via online call from her house. “I had to tell him: ‘Honey, I’m okay, I’m not hurting. I just look like someone attacked me.’”

Growing Trend of Youthful Facial Lifts

Based on plastic surgeons, Preisinger is one of a growing number of people choosing to undergo a rhytidectomy in their twenties and thirties – significantly before a decade prior to typical surgeons’ typical patient age range of 40 to 60. (Though most surgeons are keen to emphasise the professional guideline of: “We treat heredity, not age.”) “I have individuals in their late twenties requesting facelifts,” says based in London cosmetic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the facial area. “It’s a very significant surgery, and I’m a somewhat worried when I observe individuals choosing it as a lifestyle choice.”

Explaining the Facelift Procedure

A facelift, alternatively called a rhytidectomy, lifts the ligaments in the face that begin to droop as we grow older. “Human faces are built a little like layers of an onion,” says based in Kent facial plastic surgeon Marc Pacifico. “Dermis and adipose on the top, then a stratum of supportive tissue known as the SMAS. Think of the facial framework as the structural foundation of the face. And that’s what ages us; that is what becomes lax and pulls the skin down with it.”

You risk performing surgery on individuals that have deeper issues. It’s not a practice for an ethical plastic surgeon to pursue

Previously reserved of moneyed older people, “filler fatigue” – when excessive use of dermal fillers expands the face and leads to looseness in the dermis – combined with the common adoption of weight-loss drugs, cut-price surgical travel, and the development of novel, celebrity-endorsed surgical techniques are attracting a different type of customer towards this invasive surgery. Reports show an 8% increase in facial lifts over the past 12 months in the UK; while a study revealed that the portion of youthful candidates is growing, with one-third of procedures now performed on patients aged 35-55.

“People are now requesting to appear as the optimal form of themselves and obviously the techniques are evolving,” comments Orfaniotis. Currently, the operation du jour is the deep plane facelift, a technique promoted by figures including Kardashian matriarch Kris Jenner, to style creator 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 moving the deeper tissue, and avoiding the taut, pulled appearance sometimes wrought by older methods. “We’re not putting stress on the skin because we’re targeting deeper, to the underlying structures,” says Harley Street cosmetic doctor Rajiv Grover, who focuses on the advanced method. “It is the deeper tissue that is adjusted. The skin follows along as a secondary element.” Lifting the entire soft tissue layer as a single unit allows for a more natural-looking and more durable result. It also means that the surgery is no longer being used for the primary goal of youth preservation – or revitalization, as the aesthetics industry terms it – but for “beautification” and facial restructuring, too. “We’re getting numerous requests from patients aged 28 to 35 for this reason,” notes Grover.

Personal Journey

Preisinger had never planned on undergoing a facelift – at least not at the thirty years old. But years of using hyaluronic acid dermal fillers in an attempt at “symmetry correction” meant that by the time she reached her late twenties, she was “botched”. “I didn’t do this because I desired to appear youthful,” she says. “I underwent it because the injectable 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.”

If injectable substances completely disappear has long been a debated topic in the aesthetics industry. “Studies have indicated that they seldom completely dissolve,” says Grover, “but they migrate and can obstruct lymphatic channels. A contributing factor to what we term ‘puffy appearance’ is additionally the reality that to some extent, the face gets slightly waterlogged because its capacity to remove lymphatic fluid has been diminished.” Although studies into the topic is preliminary, cautionary statements on injectables’ potential impact on the lymphatic system have been issued, and additional studies initiated. One highly regarded facial plastic surgeon, commenting on the condition of anonymity, mentioned he would avoid using injectables in a client because of the risks they pose. “Many surgeons don’t want to talk about this, because the companies who produce injectables can be pretty aggressive.” He’s heard stories, he says, of cosmetic doctors facing court orders after raising their concerns.

Decision and Procedure

For Preisinger, once she started using injectables, she felt as if she had to keep adding more – particularly when it began moving to different areas of her face. She was only twenty-eight when a local plastic surgeon in the state proposed that a face and neck lift could be what she required to finally step off the cycle of treatments. Two years later, she found herself selecting from a list of suggested accommodations in Istanbul, sent to her by the clinic assistant at her surgeon’s office.

Initially, Preisinger had planned for an eyelid surgery – commonly called blepharoplasty – but her doctor advised her that a facelift was the right solution for the laxity she was finding in her face. She arranged a forehead lift, a cheek lift and a jawline surgery. The day before her operation, one day after she’d arrived alone in the country, she decided to add a mouth enhancement. “Then he said, ‘We will elevate the lower eyelid puffiness.’ He added, ‘I think if we remove some buccal fat, it will contour your face.’ So I ended up including additional procedures,” she says. She spent $22,000 (£16,500) for the half-day operation, including a three-day|