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

Amanda Preisinger feels anxious about her child’s upcoming 13th birthday celebration. It’s not due to the typical causes related to a house full of loud preteen children, but since it’s the first time she will reveal her new face to acquaintances and extended family. “Clearly I’m going to tell everyone as they arrive, ‘Just so you know, this is not how I look,’” says the 30-year-old property agent from Southern Florida.

Her appearance is, admittedly, a little startling – her face swollen and preternaturally lifted, as though secured by heavy-duty tape. Her new – and she’s eager to emphasize, temporary – appearance is the result of half a dozen aesthetic surgeries, including an endoscopic mid-facelift, conducted by a doctor in Turkey’s Istanbul, the previous month. “My poor husband became emotional when he saw me for the first time because I couldn’t even unseal my eyes. That’s how swollen I was,” she explains to me via video call from her home. “I had to tell him: ‘Babe, I’m fine, I’m not in pain. I just appear as if someone attacked me.’”

Increasing Popularity of Early Facelifts

According to plastic surgeons, Preisinger is among a rising count of people choosing to undergo a facelift in their twenties and thirties – significantly before a decade prior to most doctors’ typical patient age range of forty to sixty. (Although most surgeons are keen to emphasise the professional guideline of: “We address genetics, not age.”) “I have 28-year-olds requesting facial lifts,” states London-based aesthetic plastic surgeon Georgios Orfaniotis, a former NHS consultant who focuses on the facial area. “It’s a very significant procedure, and I’m a bit concerned when I observe individuals choosing it as a lifestyle choice.”

Explaining the Facelift Procedure

A facelift, alternatively called a facelift, lifts the tissues in the face that start to sag as we grow older. “Our faces are built a little like onion layers,” explains Kent-based facial plastic surgeon Marc Pacifico. “Skin and fat on the top, then a stratum of connective tissue called the SMAS. Think of the SMAS as the structural foundation of the face. And that is what causes aging; that is what loosens and sags and pulls the dermis down with it.”

You endanger operating on people that have deeper issues. It’s not a practice for an ethical plastic surgeon to follow

Once the preserve of affluent seniors, overuse of injectables – when overuse of injectable gels stretches the face and leads to laxity in the skin – combined with the common adoption of slimming medications, low-cost surgical travel, and the development of new, celebrity-endorsed surgical techniques are driving a different type of patient towards this major operation. Statistics show an 8% increase in facial lifts over the last year in the UK; while a study revealed that the portion of youthful candidates is increasing, with one-third of procedures now performed on patients aged thirty-five to fifty-five.

“Patients are asking now to look like the best version of themselves and obviously the methods are evolving,” comments Orfaniotis. Currently, the operation du jour is the comprehensive facial lift, a method evangelised by figures including Kardashian matriarch Kris Jenner, to style creator Marc Jacobs.

Deep Plane Technique

Where a more traditional rhytidectomy entails lifting the SMAS, the comprehensive lift loosens the facial ligaments underneath, allowing surgeons to reshape the face by moving the deeper tissue, and preventing the taut, pulled look sometimes wrought by more traditional techniques. “We’re not putting tension on the dermis because we’re going below, to the underlying structures,” says 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 single unit results in a more natural-looking and more durable outcome. It additionally implies that the surgery is not just being used for the express purpose of anti-ageing – or rejuvenation, as the cosmetic field terms it – but for “beautification” and facial restructuring, too. “We’re getting many inquiries from patients aged late twenties to mid-thirties for this reason,” says Grover.

Personal Journey

Preisinger had not intended on undergoing a facelift – at minimum not at the age of 30. But years of using hyaluronic acid dermal fillers in an effort at “facial balancing” implied that by the time she entered her late twenties, she was “botched”. “I didn’t do this because I wanted to look youthful,” she says. “I did it because the injectable harmed my face. I wish I had never done it. If I didn’t have the filler, I don’t think I would be in this situation right now.”

Whether dermal fillers ever fully dissolve has historically been a point of contention in the cosmetic field. “Studies have indicated that not only do they rarely fully dissipate,” says Grover, “but they move and can block lymphatic channels. One of the contributors to what we call ‘puffy appearance’ is additionally the reality that in a sense, the face becomes somewhat waterlogged because its capacity to drain lymphatic fluid has been reduced.” Though research into the area is preliminary, cautionary statements on injectables’ possible effects on the lymphatic system have been released, and additional studies initiated. One highly regarded facial plastic surgeon, speaking anonymously, mentioned he would never use fillers in a client because of the dangers they pose. “A lot of doctors don’t want to talk about this, because the manufacturers who produce filler can be quite forceful.” He’s heard stories, he adds, of plastic surgeons being landed with legal actions after expressing worries.

Choice and Surgery

For Preisinger, once she started injecting filler, she believed she had to keep adding more – particularly when it began moving to other parts of her face. She was only twenty-eight when a local plastic surgeon in Florida suggested that a face and neck lift could be what she needed to exit the cycle of treatments. Two years later, she ended up selecting from a list of recommended hotels in Istanbul, sent to her by the patient coordinator at her surgeon’s office.

Originally, 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 laxity she was experiencing in her face. She arranged a forehead lift, a mid-facelift and a jawline surgery. The day before her operation, one day after she’d touched down solo in Turkey, she opted to include a mouth enhancement. “Then he said, ‘We will lift the lower eyelid puffiness.’ Then he said, ‘I think if we remove some buccal fat, it will contour your face.’ Thus I ultimately adding two more surgeries,” she says. She paid $22,000 (£16,500) for the half-day operation, including a three-day|