‘My Eyes Were So Puffy I Couldn’t Even Open Them’

Amanda Preisinger experiences worry about her daughter’s impending 13th birthday celebration. It’s not due to the usual reasons associated with a house full of loud preteen kids, but because it’s the initial occasion she will debut her recently altered face to friends and extended family. “Clearly I’m going to inform all guests as they come in, ‘Just so you know, this is not how I appear,’” says the thirty-year-old real estate agent from south Florida.

Her appearance is, well, a somewhat startling – her face swollen and preternaturally lifted, as though held together by heavy-duty tape. Her new – and she’s keen to stress, temporary – look is the result of half a dozen aesthetic surgeries, such as an endoscopic mid-facelift, conducted by a surgeon in Turkey’s Istanbul, last month. “My poor husband became emotional when he viewed me for the first time because I couldn’t even unseal my eyes. That indicates swollen I was,” she explains to me via video call from her home. “I needed to inform him: ‘Honey, I’m okay, I’m not in pain. I just appear as if someone jumped me.’”

Growing Trend of Early Facelifts

Based on plastic surgeons, Preisinger is one of a growing number of individuals electing to undergo a facelift in their twenties and thirties – significantly before a decade prior to typical surgeons’ usual candidate age of forty to sixty. (Though most surgeons are keen to emphasise the industry edict of: “We treat heredity, not years.”) “I have 28-year-olds asking for facial lifts,” states London-based cosmetic surgeon Georgios Orfaniotis, a ex-NHS doctor who focuses on the head and neck. “It’s a very significant surgery, and I’m a bit concerned when I see people choosing it as a lifestyle choice.”

Explaining the Rhytidectomy Surgery

A facelift, alternatively called a rhytidectomy, elevates the tissues in the face that begin to droop as we age. “Human faces are built a bit like onion layers,” says Kent-based face specialist Marc Pacifico. “Dermis and adipose on the top, then a layer of supportive tissue known as the superficial musculoaponeurotic system. Consider the facial framework as the soft tissue skeleton of the face. And that is what causes aging; that is what loosens and sags and pulls the dermis down with it.”

You risk performing surgery on people that have underlying problems. It’s not advisable for an ethical plastic surgeon to pursue

Once the preserve of moneyed older people, “filler fatigue” – when excessive use of dermal fillers stretches the face and causes looseness in the skin – alongside the widespread use of weight-loss drugs, cut-price surgical travel, and the development of new, famous-figure-promoted surgical techniques are driving a different type of customer towards this invasive surgery. Statistics show an eight percent rise in facelifts over the past 12 months in the United Kingdom; while a study revealed that the percentage of younger facelift patients is increasing, with 32% of facelifts now conducted for individuals aged thirty-five to fifty-five.

“Patients are now requesting to look like the best version of themselves and naturally the techniques are evolving,” comments Orfaniotis. At present, the operation du jour is the comprehensive facial lift, a technique promoted by figures including Kardashian matriarch Kris Jenner, to style creator Marc Jacobs.

Deep Plane Technique

While a more traditional rhytidectomy involves elevating the superficial layer, the comprehensive lift releases the underlying structures beneath it, allowing doctors to reshape the face by repositioning the deeper tissue, and avoiding the taut, pulled appearance sometimes wrought by more traditional techniques. “We’re not putting stress on the dermis because we’re targeting deeper, to the deeper tissue,” explains prestigious London cosmetic doctor Rajiv Grover, who focuses on the advanced method. “It is the deeper tissue that is repositioned. The dermis follows along as a passenger.” Lifting the entire soft tissue layer as a unified block results in a more natural-looking and longer-lasting result. It also means that the surgery is not just being used for the express purpose of anti-ageing – or rejuvenation, as the aesthetics industry describes it – but for “enhancement” and contouring, too. “We receive many inquiries from patients aged 28 to 35 for this reason,” says Grover.

Individual Experience

Preisinger had not intended on getting a facial lift – at least not at the thirty years old. But long-term using hyaluronic acid dermal fillers in an effort at “symmetry correction” implied that by the time she reached her late 20s, she was “damaged”. “I didn’t undergo this because I desired to appear young,” she clarifies. “I did it because the filler ruined my face. I regret ever done it. If I had avoided the injectable, I don’t believe I would be where I’m at currently.”

Whether injectable substances completely disappear has long been a point of contention in the aesthetics industry. “Studies have shown that they seldom fully dissipate,” states Grover, “but they migrate and can obstruct lymphatic channels. One of the contributors to what we call ‘puffy appearance’ is additionally the reality that in a sense, the face gets somewhat waterlogged because its ability to drain lymphatic fluid has been diminished.” Although research into the topic is early-stage, warnings on dermal fillers’ potential impact on the lymphatic system have been released, and further research announced. An esteemed facial plastic surgeon, speaking on the condition of anonymity, mentioned he would never use injectables in a patient because of the risks they present. “Many surgeons avoid talk about this, because the manufacturers who make filler can be quite forceful.” He’s heard stories, he says, of plastic surgeons facing court orders after raising their concerns.

Choice and Surgery

For Preisinger, after beginning injecting filler, she believed she needed to continue adding more – especially as it began moving 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 Istanbul, sent to her by the patient coordinator 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 right solution for the looseness she was experiencing in her face. She booked a forehead lift, a mid-facelift and a neck lift. The eve of her operation, 24 hours post she’d touched down alone in the country, she opted to include a lip lift. “Subsequently the surgeon said, ‘We’re going to lift the lower eyelid puffiness.’ Then he said, ‘I think if we remove some cheek fat, it will contour your face.’ So I ended up adding two more surgeries,” she recalls. She paid $22,000 (sixteen thousand five hundred pounds) for the half-day surgery, plus a three-day|