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

Amanda Preisinger feels anxious about her child’s upcoming 13th birthday celebration. It’s not due to the typical causes associated with a home packed of clamorous adolescent children, but since it’s the first time she will showcase her recently altered face to acquaintances and extended family. “Clearly I’m going to tell all guests as they come in, ‘For your information, this is not how I appear,’” states the 30-year-old real estate agent from Southern Florida.

Her appearance is, well, a somewhat startling – her face puffed up and preternaturally lifted, as though held together by industrial-grade tape. Her new – and she’s keen to stress, short-term – appearance is the result of six aesthetic surgeries, such as an endoscopic mid-facelift, conducted by a doctor in Turkey’s Istanbul, the previous month. “My poor husband teared up when he saw me for the initial time because I wasn’t able to even open my eyes. That indicates puffy I was,” she explains to me via online call from her house. “I had to tell him: ‘Honey, I’m fine, I’m not hurting. I just look like someone attacked me.’”

Growing Trend of Early Facelifts

According to plastic surgeons, Preisinger is one of a rising count of individuals choosing to undergo a facelift in their 20s and 30s – significantly before a decade prior to typical surgeons’ usual candidate age of forty to sixty. (Though most surgeons are keen to emphasise the professional guideline of: “We treat genetics, not age.”) “I have individuals in their late twenties asking for facial lifts,” states London-based aesthetic plastic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the facial area. “It’s a major procedure, and I’m a bit concerned when I observe individuals choosing it as a personal preference.”

Explaining the Rhytidectomy Surgery

A rhytidectomy, alternatively called a facelift, lifts the ligaments in the face that start to sag as we age. “Our faces are built a little like layers of an onion,” says Kent-based facial plastic surgeon Marc Pacifico. “Skin and fat on the top, then a stratum of connective tissue called the superficial musculoaponeurotic system. Consider the facial framework as the structural foundation of the face. And that’s what causes aging; that is what loosens and sags and pulls the skin down with it.”

You risk operating on individuals that have deeper issues. It’s not a practice for an conscientious surgeon to follow

Once the preserve of moneyed older people, “filler fatigue” – when excessive use of dermal fillers expands the face and leads to laxity in the skin – alongside the widespread use of weight-loss drugs, low-cost medical tourism, and the advancement of new, celebrity-endorsed operative methods are driving 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 one-third of procedures now conducted for patients aged 35-55.

“People are asking now to look like the optimal form of themselves and naturally the methods are evolving,” says Orfaniotis. At present, the trending procedure is the deep plane facelift, a method promoted by figures including Kardashian matriarch Kris Jenner, to style creator Marc Jacobs.

Deep Plane Technique

Where a more traditional rhytidectomy involves elevating the superficial layer, the deep plane facelift releases the underlying structures underneath, enabling surgeons to reshape the face by moving the underlying layers, and avoiding the taut, pulled appearance occasionally caused by more traditional techniques. “We’re not putting stress on the dermis because we’re going below, to the underlying structures,” explains Harley Street plastic surgeon Rajiv Grover, who specialises in the deep plane technique. “It is the underlying layers that is repositioned. The dermis follows along as a passenger.” Lifting the entire soft tissue layer as a single unit allows for a more natural-looking and more durable result. It additionally implies that the procedure is not just being used for the express purpose of anti-ageing – or rejuvenation, as the cosmetic field terms it – but for “enhancement” and facial restructuring, too. “We receive many inquiries from patients aged late twenties to mid-thirties for this purpose,” says Grover.

Personal Journey

Preisinger had not intended on undergoing a facelift – at least not at the age of 30. But years of using hyaluronic acid dermal fillers in an attempt at “symmetry correction” meant that by the time she reached her late 20s, she was “damaged”. “I didn’t do this because I wanted to look youthful,” she clarifies. “I did it because the filler ruined my face. I wish I had never done it. If I didn’t have the injectable, I don’t think I would be where I’m at currently.”

If dermal fillers ever fully dissolve has long been a point of contention in the cosmetic field. “Research have shown that not only do they rarely completely dissolve,” says Grover, “but they migrate and can block lymphatic channels. One of the contributors to what we term ‘puffy appearance’ is also the fact that to some extent, the face gets slightly waterlogged because its capacity to drain bodily fluid has been diminished.” Though research into the topic is preliminary, warnings on injectables’ potential impact on the body’s drainage have been released, and additional studies initiated. An esteemed face specialist, commenting anonymously, says he would avoid using fillers in a client because of the dangers they present. “A lot of doctors avoid discussing this, because the manufacturers who produce injectables can be pretty aggressive.” He’s heard stories, he says, of cosmetic doctors facing legal actions after expressing worries.

Choice and Surgery

For Preisinger, after beginning using injectables, she believed she needed to continue adding more – especially as it started to migrate to different areas of her face. She was only twenty-eight when a local plastic surgeon in Florida suggested that a face and neck lift might be what she required to finally step off the injectable hamster wheel. After 24 months, she found herself choosing between a selection of recommended hotels in the city, texted to her by the clinic assistant at her surgeon’s office.

Originally, Preisinger had scheduled an upper and lower blepharoplasty – commonly called eyelid surgery – but her surgeon recommended that a facelift was the correct option for the looseness she was finding in her face. She arranged a brow lift, a mid-facelift and a jawline surgery. The eve of her operation, 24 hours post she’d arrived alone in Turkey, she opted to include a mouth enhancement. “Then he said, ‘We’re going to lift the under-eye bags.’ Then he said, ‘I believe if we extract some buccal fat, it will sculpt your face.’ Thus I ultimately including additional surgeries,” she recalls. She paid $22,000 (£16,500) for the half-day operation, including a three-day|