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

Amanda Preisinger experiences worry about her daughter’s impending 13th birthday celebration. Not for the usual causes associated with a home packed of clamorous adolescent children, but because it’s the first time she will reveal her recently altered face to friends and relatives. “Obviously I’m going to tell everyone as they come in, ‘For your information, this is not the way I look,’” says the thirty-year-old real estate agent from south Florida.

Her appearance is, well, a somewhat surprising – her face puffed up and preternaturally lifted, as though held together by heavy-duty tape. Her new – and she’s eager to emphasize, temporary – look is the result of six cosmetic procedures, such as an endoscopic mid-facelift, conducted by a surgeon in Turkey’s Istanbul, the previous month. “My poor husband became emotional when he saw me for the first time because I wasn’t able to even open my eyes. That indicates puffy I was,” she tells me via video call from her home. “I had to tell him: ‘Honey, 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 individuals choosing to have a rhytidectomy in their twenties and thirties – significantly before a decade before typical surgeons’ typical patient age range of 40 to 60. (Although many specialists are eager to highlight the professional guideline of: “We address genetics, not age.”) “I have individuals in their late twenties asking for facial lifts,” says London-based cosmetic surgeon Georgios Orfaniotis, a ex-NHS doctor who focuses on the facial area. “It’s a major surgery, and I’m a bit concerned when I see people opting for it as a personal preference.”

Explaining the Rhytidectomy Surgery

A rhytidectomy, alternatively called a rhytidectomy, elevates the ligaments in the face that begin to droop as we age. “Human faces are built a little like layers of an onion,” explains based in Kent facial plastic surgeon Marc Pacifico. “Skin and fat on the surface, then a layer of supportive tissue known as the superficial musculoaponeurotic system. Think of the SMAS as the structural foundation of the face. And that is what causes aging; that is what becomes lax and pulls the dermis downward with it.”

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

Once the preserve of moneyed older people, overuse of injectables – when excessive use of injectable gels stretches the face and leads to looseness in the dermis – combined with the common adoption of weight-loss drugs, low-cost surgical travel, and the advancement of novel, celebrity-endorsed operative methods are attracting a new kind of patient towards this invasive surgery. Reports indicate an 8% increase in facelifts over the last year in the United Kingdom; while a study found that the percentage of younger facelift patients is increasing, with one-third of procedures now conducted for patients aged 35-55.

“Patients are now requesting to look like the best version of themselves and obviously the methods are evolving,” says Orfaniotis. Currently, the operation du jour is the comprehensive facial lift, a technique evangelised by everyone from Kardashian matriarch Kris Jenner, to style creator Marc Jacobs.

Advanced Lifting Method

Where a more traditional rhytidectomy involves elevating the superficial layer, the comprehensive lift releases the facial ligaments underneath, enabling doctors to reshape the face by repositioning the deeper tissue, and preventing the tight, stretched look occasionally caused by older methods. “We avoid placing stress on the skin because we’re targeting deeper, to the underlying structures,” explains Harley Street plastic surgeon Rajiv Grover, who focuses on the advanced method. “It is the deeper tissue that is repositioned. The dermis comes with it as a passenger.” Lifting the entire soft tissue layer as a single unit results in a more natural-looking and more durable result. It also means that the procedure is no longer being used for the primary goal of youth preservation – or rejuvenation, as the aesthetics industry describes it – but for “enhancement” and contouring, too. “We’re getting many inquiries from clients aged 28 to 35 for this purpose,” says Grover.

Personal Journey

Preisinger had never planned on undergoing a facelift – at least not at the age of 30. But years of using injectable gels in an attempt at “symmetry correction” meant that by the time she reached her late twenties, she was “botched”. “I didn’t undergo this because I wanted to look young,” she says. “I underwent it because the filler harmed my face. I wish I had never done it. If I had avoided the filler, I don’t think I would be where I’m at currently.”

Whether injectable substances completely disappear has historically been a point of contention in the aesthetics industry. “Research have shown that they seldom fully dissipate,” says Grover, “but they migrate and can obstruct drainage pathways. A contributing factor to what we term ‘puffy appearance’ is also the fact that in a sense, the face gets somewhat waterlogged because its capacity to drain bodily fluid has been reduced.” Though research into the area is early-stage, cautionary statements on dermal fillers’ potential impact on the lymphatic system have been issued, and additional studies announced. An esteemed facial plastic surgeon, commenting on the condition of anonymity, mentioned he would avoid using injectables in a client because of the dangers they pose. “Many doctors avoid discussing this, because the companies who produce injectables can be pretty aggressive.” He’s heard stories, he adds, of plastic surgeons facing court orders after raising their concerns.

Decision and Procedure

For Preisinger, once she started using injectables, she felt as if she needed to continue adding more – particularly when it started to migrate to different areas of her face. She was only twenty-eight when a local plastic surgeon in Florida proposed that a facial and neck surgery might be what she needed to exit the injectable hamster wheel. Two years later, she found herself choosing between a list of suggested accommodations in the city, texted to her by the patient coordinator at her doctor’s clinic.

Originally, Preisinger had scheduled an eyelid surgery – commonly called eyelid surgery – but her surgeon advised her that a facelift was the correct option for the laxity she was finding in her face. She booked a forehead lift, a cheek lift and a jawline surgery. The day before her operation, 24 hours post she’d arrived solo in Turkey, she decided to add a lip lift. “Subsequently the surgeon stated, ‘We’re going to elevate the under-eye bags.’ He added, ‘I think if we extract some buccal fat, it will contour your face.’ So I ended up adding two more procedures,” she says. She spent $22,000 (£16,500) for the six-hour surgery, including a three-day|