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

Amanda Preisinger feels anxious about her child’s upcoming 13th birthday party. Not for the typical reasons associated with a house full of clamorous adolescent kids, but since it’s the initial occasion she will reveal her recently altered face to friends and relatives. “Obviously I’m going to inform all guests as they arrive, ‘Just so you know, this is not the way I look,’” states the 30-year-old real estate agent from south Florida.

Her appearance is, admittedly, a little startling – her face swollen and preternaturally lifted, as though secured by heavy-duty tape. Her altered – and she’s eager to emphasize, short-term – appearance is the outcome of half a dozen aesthetic surgeries, including an endoscopic mid-facelift, conducted by a surgeon in Istanbul, Turkey, the previous month. “My poor husband became emotional when he saw me for the first time because I wasn’t able to even unseal my eyes. That’s how swollen I was,” she tells me via online call from her home. “I needed to inform him: ‘Honey, I’m fine, I’m not hurting. I just appear as if someone jumped me.’”

Growing Trend of Youthful Facial Lifts

Based on cosmetic specialists, Preisinger is one of a growing number of individuals choosing to undergo a rhytidectomy in their 20s and 30s – well over a ten years before most doctors’ typical patient age range of forty to sixty. (Though many specialists are keen to emphasise the professional guideline of: “We treat genetics, not years.”) “I have 28-year-olds requesting facial lifts,” says London-based aesthetic plastic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the head and neck. “It’s a major surgery, and I’m a somewhat worried when I observe individuals opting for it as a personal preference.”

Understanding the Rhytidectomy Surgery

A facelift, alternatively called a rhytidectomy, elevates the tissues in the face that begin to droop as we grow older. “Our faces are built a bit like onion layers,” explains Kent-based face specialist Marc Pacifico. “Dermis and adipose on the top, then a stratum of supportive tissue called the superficial musculoaponeurotic system. Consider the SMAS as the soft tissue skeleton of the face. And that is what causes aging; that’s what loosens and sags and drags the dermis downward with it.”

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

Once the preserve of affluent seniors, overuse of injectables – when excessive use of injectable gels stretches the face and causes laxity in the skin – combined with the common adoption of weight-loss drugs, cut-price surgical travel, and the development of novel, celebrity-endorsed surgical techniques are driving a different type of customer towards this major operation. Reports show an 8% increase in facelifts over the past 12 months in the UK; while a study found that the percentage of youthful candidates is increasing, with one-third of procedures now conducted for individuals aged thirty-five to fifty-five.

“Patients are asking now to look like the optimal form of themselves and obviously the techniques are following,” says Orfaniotis. At present, the trending procedure is the deep plane facelift, a technique evangelised by everyone from Kardashian matriarch Kris Jenner, to fashion designer Marc Jacobs.

Deep Plane Technique

Where a more traditional facelift entails elevating the superficial layer, the deep plane facelift loosens the underlying structures beneath it, allowing doctors to reshape the face by moving the deeper tissue, and preventing the taut, pulled appearance occasionally caused by older methods. “We’re not putting tension on the skin because we’re going below, to the deeper tissue,” says prestigious London plastic surgeon Rajiv Grover, who specialises in the advanced method. “It is the underlying layers that is repositioned. The skin follows along as a passenger.” Elevating the entire soft tissue layer as a single unit results in a more natural-looking and more durable result. It additionally implies that the procedure is not just being used for the primary goal of youth preservation – or revitalization, as the aesthetics industry terms it – but for “enhancement” and facial restructuring, too. “We receive numerous requests from patients aged 28 to 35 for this reason,” says Grover.

Personal Journey

Preisinger had never planned on undergoing a facelift – at minimum not at the age of 30. But years of using hyaluronic acid dermal fillers in an effort at “symmetry correction” meant that by the time she reached her late twenties, she was “botched”. “I didn’t undergo this because I desired to appear youthful,” she clarifies. “I underwent it because the injectable harmed my face. I wish I had never using it. If I had avoided the injectable, I don’t think I would be where I’m at currently.”

If injectable substances completely disappear has historically been a debated topic in the aesthetics industry. “Studies have indicated that they seldom fully dissipate,” states Grover, “but they migrate and can block drainage pathways. One of the contributors to what we call ‘puffy appearance’ is additionally the fact that to some extent, the face gets slightly fluid-filled because its ability to remove bodily fluid has been diminished.” Although research into the topic is early-stage, cautionary statements on injectables’ potential impact on the lymphatic system have been released, and further research announced. One highly regarded facial plastic surgeon, speaking on the condition of anonymity, says he would never use fillers in a client because of the risks they present. “A lot of surgeons don’t want to talk about this, because the manufacturers who make filler 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, after beginning injecting filler, she felt as if she needed to continue adding more – especially as it began moving to other parts of her face. She was just 28 when a nearby cosmetic doctor in the state proposed that a facial and neck surgery might be what she required to finally step off the cycle of treatments. After 24 months, she found herself selecting from a selection of suggested accommodations in Istanbul, texted 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 recommended that a facial lift was the right solution for the looseness she was experiencing in her face. She booked a forehead lift, a mid-facelift and a jawline surgery. The eve of her surgery, one day after she’d touched down solo in the country, she decided to add a lip lift. “Then he said, ‘We will lift the lower eyelid puffiness.’ Then he said, ‘I believe if we extract some cheek fat, it will contour your face.’ So I ended up including additional surgeries,” she says. She paid $22,000 (£16,500) for the half-day surgery, including a three-day|