Amanda Preisinger is feeling nervous about her daughter’s approaching 13th birthday celebration. Not due to the typical concerns of managing a house filled with noisy preteens, but because it’s the inaugural occasion she will showcase her new appearance to friends and relatives. “Naturally I’ll inform everyone as they arrive, ‘Just so you are aware, this isn’t how I normally look,’” states the 30-year-old real estate professional from southern Florida.
Her appearance is somewhat shocking – her face appears swollen and unusually lifted, like it’s been held together with industrial-strength tape. Her new – and she emphasizes, temporary – look results from six cosmetic procedures, including an endoscopic mid-facelift, carried out by a physician in Istanbul, Turkey, last month. “My poor husband had tears in his eyes when he first saw me because I couldn’t even open my eyes. That’s how swollen I was,” she recounts during a video call from her home. “I had to reassure him: ‘Honey, I’m alright, I’m not in pain. I just look like I’ve been in a fight.’”
Plastic surgeons note that Preisinger is among an increasing crowd of individuals opting for facelifts in their 20s and 30s – significantly younger than the usual patient demographic of 40 to 60 years old. (Although many surgeons stress the principle of: “We address genetics, not age.”) “I have young individuals, as young as 28, requesting facelifts,” mentions London-based cosmetic surgeon Georgios Orfaniotis, a former NHS consultant who focuses on the head and neck. “It’s a substantial procedure, and I feel uneasy when I encounter individuals viewing it as a lifestyle decision.”
A facelift, or rhytidectomy, elevates the facial ligaments that start to sag with age. “Our faces are structured somewhat like an onion’s layers,” explains Kent-based facial plastic surgeon Marc Pacifico. “There’s skin and fat on top, followed by a layer of connective tissue called the SMAS – the superficial musculoaponeurotic system. Consider the SMAS as the soft tissue framework of the face. This is what shows signs of aging; it loosens, droops, and causes the skin to sag.”
Once exclusive to the wealthy elderly, “filler fatigue” – where excessive use of dermal fillers stretches the face and causes skin laxity – combined with the popularity of weight loss medications, affordable medical tourism, and the emergence of new, celebrity-backed surgical methods are attracting a fresh audience to this invasive procedure. The British Association of Aesthetic Plastic Surgeons (BAAPS) has documented an 8% increase in facelifts in the UK over the last year; a survey from the American Academy of Facial Plastic and Reconstructive Surgery showed a growing number of younger patients, with 32% of facelifts now performed on those aged 35-55.
“Patients are now looking to appear as the best version of themselves and the techniques are evolving accordingly,” Orfaniotis notes. Presently, the sought-after procedure is the deep plane facelift, a technique popularized by figures like Kris Jenner and designer Marc Jacobs.
Unlike a traditional facelift which focuses on lifting the SMAS, the deep plane facelift frees the facial ligaments located beneath it, providing surgeons the ability to redefine the face by repositioning the deeper tissues, which helps evade the stretched, taut appearance that can result from conventional techniques. “We’re not straining the skin because we work underneath, at a deeper level,” explains Harley Street surgeon Rajiv Grover, who specializes in the deep plane method. “It’s the underlying tissue that gets adjusted. The skin simply moves along with it.” Elevating the whole soft tissue layer as a unified entity results in a more authentic and durable outcome. Furthermore, this procedure is now being utilized not just for anti-aging purposes – or rejuvenation, as framed by the aesthetics field – but also for “enhancing beauty” and altering facial structure. “We’re receiving numerous requests from individuals aged 28 to 35 for this reason,” Grover elaborates.
Preisinger never intended to get a facelift – at least not at 30. However, years of utilizing hyaluronic acid fillers in pursuit of “facial balance” left her feeling “botched” by her late 20s. “I didn’t undergo this to seem younger,” she shares. “I did it because the filler damaged my face. I regret having done it. Had I not used the filler, I don’t believe I’d be in this situation now.”
The question of whether dermal fillers ever completely dissolve has been a long-standing debate within the aesthetics sector. “Research indicates that they seldom completely dissolve,” Grover asserts, “and they can migrate, leading to blockages in lymphatic channels. One of the factors contributing to what’s colloquially termed ‘pillow face’ is how the face becomes somewhat waterlogged due to its diminished capacity to drain lymphatic fluid.” Although studies in this field are in the early stages, BAAPS recently released a cautionary advisory concerning the possible effects of dermal fillers on the lymphatic system during their 2023 scientific conference and signaled the need for further study. One well-respected facial plastic surgeon, who spoke to me anonymously, indicated he would never employ fillers in a patient due to the associated risks. “Many surgeons prefer not to voice concerns about this, particularly since the companies that produce fillers can be quite aggressive.” He has heard anecdotes of US-based plastic surgeons facing legal troubles for expressing their apprehensions.
For Preisinger, after she began using fillers, it felt necessary to maintain them – especially as they started to shift across her face. At 28, a local plastic surgeon in Florida recommended a face and neck lift as the way to finally break free from the injectable cycle. Two years later, she found herself considering different hotel options in Istanbul, suggested by the patient coordinator from her surgeon’s practice.
Initially, Preisinger intended to pursue an upper and lower blepharoplasty – commonly referred to as eyelid surgery – but her surgeon indicated that a facelift would be more effective for addressing the looseness she observed in her face. She scheduled a forehead lift, mid-facelift, and neck lift. The day prior to her surgery, right after arriving alone in Turkey, she opted to include a lip lift. “Then he [the surgeon] mentioned, ‘We can lift the under-eye bags.’ Then he said, ‘I believe removing some buccal fat will enhance your face’s contours.’ Consequently, I decided to add two additional procedures,” she shares. The total cost for her six-hour surgery amounted to $22,000 (£16,500), plus a three-day stay in a luxurious medical suite, which resembled more of an upscale hotel than a hospital. (Her actual hotel, where she would recuperate for an additional four days with ice packs and a strictly liquid diet, was a separate expense.)
Facelift prices in the UK range from thousands to high double digits, largely depending on the surgeon. “It’s quite odd: the more procedures you opt for, the more economical it becomes,” remarks 40-year-old Lucy Argent, who underwent a deep plane necklift two years ago. Originally from Cambridge, Argent now resides with her family in Bali and had always felt self-conscious about her neck and chin. Thus, when a UK clinic quoted her £5,000 for a partial deep plane neck lift (essentially reshaping the tissue without making skin alterations), she readily accepted. “I had never undergone cosmetic surgery before,” she recalls. “It’s akin to being a child in a candy shop. You’re discussing substantial surgeries, yet during consultations, they’re encouraging, ‘If you wish to add a brow lift or breast lift, you can. Liposuction on your arms is also an option.’ I left feeling at least I was making a logical decision. They offered financing options, making it feel less like a financial burden. However, it did leave me slightly uncomfortable.” Following the birth of her third child, she decided to add a breast lift to her package, raising her total investment to approximately £9,000.
“I was taken aback by how accessible it felt,” she explains. “Having just come out of the postpartum stage, it was a vulnerable time. Despite the kindness of everyone at the clinic, I believe the plastic surgery field capitalizes on women who feel dissatisfied with their postnatal bodies and search for their identities. I could have opted for numerous procedures without anyone cautioning me. No one suggested, ‘Perhaps you should take a year to exercise or try a specific diet.’ I’m currently in a vastly different mental state than I was two years ago.”
All the surgeons I consulted for this article noted that while it varies case by case, they would be hesitant to perform surgeries on patients in their 20s and 30s solely for aesthetic motivations. “You can enhance a 28-year-old’s jawline,” Orfaniotis states. “You can elevate their appearance to their peak self. But where does this trend stop? Surgery for beautification on people in their 20s or early 30s who otherwise appear perfectly fine risks engaging with individuals who may have deeper psychological concerns. It’s not an ethical approach for a responsible plastic surgeon.” Despite this, when I made a few casual inquiries with Turkish surgeons, none of them implied that at 28, I might be too young for a deep plane facelift. I attempt – and fail – to take it personally.
Amy Endean, a 34-year-old supported living facility manager from Worcestershire, faced initial rejection from her plastic surgeon four years ago when she inquired about a facelift. This only reaffirmed her prior research confirming he was indeed the right match for her.
At 16, Endean was a passenger in a vehicle that crashed into a wall during a high-speed turn. She experienced severe facial injuries, prompting extensive reconstructive surgery. “They essentially removed my entire face from the chin upwards,” she explains. Surgeons repaired part of her jaw and nose, and inserted titanium plates into the fractured areas of her skull. Over the next decade, she underwent significant surgeries nearly every year.
By age 25, she recognized the need for substantial plastic surgery due to the facial movement. She developed a double chin that obstructed her ability to breathe or swallow while lying down – a consequence of her facial fat settling in her chin post-surgery. While 30, her appearance was similar to someone in their 60s. Following extensive discussions with both her family and her surgeon, she finally received approval for a deep plane facelift, brow lift, and chin implant. “It didn’t make me appear drawn or overdone – it merely restored my appearance to what’s appropriate for my age,” she recalls four years later. She might require additional, minor adjustments in the future – just last year, a swollen lump beneath her eye was found to be a metal fragment from the accident still lodged in her face – but thanks to her facelift, she avoids the necessity for yearly surgeries. Since the operation, she has gotten married and welcomed two children, which she believes wouldn’t have been feasible had she continually undergone hospital visits.
When private cosmetic surgeons promote the transformative potential of their work on social media – usually alongside a before-and-after of a tech executive or a social media influencer – it’s hard to not roll one’s eyes. Yet, for individuals like Endean, the advancements in these procedures genuinely have been life-altering. “I can’t imagine what I’d look like if the accident had never occurred,” she states. “But I feel like I still resemble my true self.”
As for Preisinger, she adheres to a rigorous post-operative routine of ice-rolling and facial massages, hoping for the swelling to subside soon. In six to eight months, she plans to return to Istanbul for a follow-up with her surgeon – a brief stopover en route to Italy for a family vacation. “I’m so looking forward to it,” she exclaims. “I know my results will be outstanding.”
