‘My Eyes Were So Puffy I Was Unable to Even Unseal Them’

Amanda Preisinger is nervous about her daughter’s upcoming 13th birthday party. Not for the typical reasons associated with a house full of loud preteen kids, but since it’s the initial occasion she will debut her new face to friends and relatives. “Clearly I’m going to tell everyone as they come in, ‘For your information, this is not how I look,’” states the thirty-year-old real estate agent from Southern Florida.

Her appearance is, admittedly, a little surprising – her face puffed up and unnaturally tightened, as though held together by heavy-duty tape. Her altered – and she’s keen to stress, temporary – appearance is the result of half a dozen aesthetic surgeries, such as an endoscopic mid-facelift, performed by a doctor in Istanbul, Turkey, last month. “My spouse teared up when he viewed me for the first time because I couldn’t even unseal my eyes. That indicates swollen I was,” she tells me via online call from her home. “I had to tell him: ‘Honey, I’m okay, I’m not hurting. I just appear as if someone attacked me.’”

Increasing Popularity of Early Facelifts

According to plastic surgeons, Preisinger is one of a growing number of people choosing to have a facelift in their 20s and 30s – well over a ten years before most doctors’ typical patient age range of forty to sixty. (Although most surgeons are keen to emphasise the industry edict of: “We treat genetics, not age.”) “I have individuals in their late twenties requesting facial lifts,” states London-based cosmetic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the head and neck. “It’s a major procedure, and I’m a bit concerned when I see individuals choosing it as a lifestyle choice.”

Explaining the Facelift Procedure

A rhytidectomy, alternatively called a rhytidectomy, elevates the ligaments in the face that start to sag as we age. “Our faces are built a little like layers of an onion,” explains Kent-based face specialist Marc Pacifico. “Dermis and adipose on the top, then a stratum of supportive tissue known as the superficial musculoaponeurotic system. Think of the facial framework as the structural foundation of the face. And that is what ages us; that is what loosens and sags and pulls the skin down with it.”

You risk operating on people that have deeper issues. It’s not advisable 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 looseness in the skin – combined with the common adoption of slimming medications, low-cost surgical travel, and the advancement of novel, famous-figure-promoted surgical techniques are attracting a new kind of customer towards this major operation. Statistics show an 8% increase in facelifts over the last year in the United Kingdom; while a study found that the percentage of youthful candidates is growing, with one-third of procedures now performed on patients aged thirty-five to fifty-five.

“People are now requesting to appear as the best version of themselves and obviously the techniques are evolving,” comments Orfaniotis. Currently, the operation du jour is the comprehensive facial lift, a technique promoted by everyone from Kardashian matriarch Kris Jenner, to style creator Marc Jacobs.

Deep Plane Technique

Where a more traditional rhytidectomy involves elevating the superficial layer, the comprehensive lift loosens the facial ligaments underneath, enabling doctors to reshape the face by moving the underlying layers, and preventing the taut, pulled look occasionally caused by more traditional techniques. “We avoid placing stress on the dermis because we’re targeting deeper, to the underlying structures,” explains prestigious London cosmetic doctor Rajiv Grover, who focuses on the deep plane technique. “It is the deeper tissue that is adjusted. The dermis follows along as a passenger.” Elevating the whole facial structure as a unified block allows for a authentic-appearing and more durable outcome. It additionally implies that the surgery is not just being used for the primary goal of youth preservation – or revitalization, as the aesthetics industry terms it – but for “beautification” and contouring, too. “We receive many inquiries from patients aged 28 to 35 for this reason,” says Grover.

Personal Journey

Preisinger had never planned on getting a facial lift – at least not at the thirty years old. But long-term using hyaluronic acid dermal fillers in an attempt at “facial balancing” implied that by the time she reached her late 20s, she was “botched”. “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 believe I would be in this situation currently.”

Whether injectable substances ever fully dissolve has historically been a point of contention in the aesthetics industry. “Studies have shown that not only do they rarely completely dissolve,” states Grover, “but they move and can obstruct drainage pathways. A contributing factor to what we term ‘pillow face’ is additionally the fact that in a sense, the face gets somewhat fluid-filled because its capacity to remove bodily fluid has been reduced.” Though studies into the area is preliminary, cautionary statements on injectables’ possible effects on the body’s drainage have been released, and additional studies announced. One highly regarded facial plastic surgeon, commenting anonymously, mentioned he would never use injectables in a patient because of the risks they present. “A lot of doctors avoid discussing this, because the manufacturers who make filler can be quite forceful.” He’s been told accounts, he says, of plastic surgeons facing legal actions after raising their concerns.

Decision and Procedure

For Preisinger, after beginning injecting filler, she believed she had to keep replenishing it – especially as it started to migrate to different areas of her face. She was only twenty-eight when a local plastic surgeon in the state suggested that a face and neck lift could be what she needed to finally step off the injectable hamster wheel. Two years later, she found herself selecting from a list of recommended hotels in Istanbul, texted to her by the clinic assistant at her surgeon’s office.

Initially, Preisinger had planned for an upper and lower blepharoplasty – better known as eyelid surgery – but her doctor advised her that a facelift was the correct option for the looseness she was finding in her face. She arranged a forehead lift, a mid-facelift and a jawline surgery. The eve of her operation, one day after she’d touched down alone in the country, she decided to add a lip lift. “Subsequently the surgeon stated, ‘We will elevate the lower eyelid puffiness.’ Then he said, ‘I believe if we remove some buccal fat, it will sculpt your face.’ So I ended up adding two more surgeries,” she recalls. She spent $22,000 (£16,500) for the six-hour operation, including a three-day|