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

Amanda Preisinger is nervous about her child’s impending 13th birthday celebration. Not for the usual causes associated with a house full of clamorous preteen children, but because it’s the initial occasion she will debut her new face to friends and extended family. “Obviously I’m going to tell everyone as they come in, ‘Just so you know, this is not how I look,’” says the 30-year-old property agent from Southern Florida.

How she looks is, well, a somewhat surprising – her face puffed up and unnaturally tightened, as though held together by industrial-grade tape. Her altered – and she’s keen to stress, temporary – appearance is the outcome of six cosmetic procedures, including an endoscopic mid-facelift, performed by a doctor in Istanbul, Turkey, the previous month. “My poor husband teared up when he viewed me for the initial time because I couldn’t even open my eyes. That’s how puffy I was,” she tells me via video call from her house. “I had to tell him: ‘Babe, I’m okay, I’m not hurting. I just look like someone attacked me.’”

Growing Trend of Youthful Facial Lifts

According to cosmetic specialists, Preisinger is among a growing number of individuals choosing to have a facelift in their 20s and 30s – well over a ten years before most doctors’ 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 requesting facial lifts,” says London-based cosmetic surgeon Georgios Orfaniotis, a former NHS consultant who specialises in the head and neck. “It’s a major surgery, and I’m a bit concerned when I see individuals choosing it as a lifestyle choice.”

Understanding the Rhytidectomy Surgery

A rhytidectomy, also known as a rhytidectomy, elevates the ligaments in the face that start to sag as we grow older. “Human faces are structured a little like onion layers,” explains Kent-based face specialist Marc Pacifico. “Dermis and adipose on the surface, then a stratum of supportive tissue known as the superficial musculoaponeurotic system. Think of the SMAS as the structural foundation of the face. And that is what ages us; that is what becomes lax and pulls the dermis down with it.”

You risk operating on individuals that have deeper issues. It’s not advisable for an ethical plastic surgeon to pursue

Once the preserve of affluent seniors, “filler fatigue” – when excessive use of injectable gels expands the face and causes looseness in the skin – combined with the common adoption of weight-loss drugs, cut-price medical tourism, and the development of new, famous-figure-promoted surgical techniques are driving a new kind of customer towards this major operation. Reports indicate an 8% increase in facial lifts over the past 12 months in the UK; while a survey revealed that the percentage of youthful candidates is increasing, with one-third of procedures now conducted for patients aged 35-55.

“People are asking now to look like the optimal form of themselves and naturally the techniques are evolving,” says Orfaniotis. Currently, the operation du jour is the comprehensive facial lift, a technique evangelised by figures including reality TV star Kris Jenner, to style creator Marc Jacobs.

Deep Plane Technique

While a more traditional facelift involves elevating the SMAS, the comprehensive lift loosens the facial ligaments beneath it, enabling surgeons to restructure the face by moving the underlying layers, and avoiding the tight, stretched appearance sometimes wrought by more traditional techniques. “We avoid placing stress on the skin because we’re targeting deeper, to the deeper tissue,” explains prestigious London cosmetic doctor Rajiv Grover, who specialises in the deep plane technique. “It is the underlying layers that is repositioned. The skin comes with it as a secondary element.” Elevating the entire soft tissue layer as a single unit results in a more natural-looking and longer-lasting outcome. It additionally implies that the surgery is no longer being used for the primary goal of youth preservation – or revitalization, as the cosmetic field describes it – but for “enhancement” and contouring, too. “We’re getting numerous requests from clients aged 28 to 35 for this reason,” says Grover.

Personal Journey

Preisinger had not intended on getting a facial lift – at minimum not at the age of 30. But long-term using hyaluronic acid dermal fillers in an effort at “symmetry correction” implied that by the time she entered her late 20s, she was “botched”. “I didn’t do this because I desired to appear youthful,” she says. “I underwent it because the injectable harmed my face. I regret ever using it. If I had avoided the filler, I don’t think I would be where I’m at currently.”

If injectable substances completely disappear has long been a point of contention in the cosmetic field. “Studies have shown that they seldom completely dissolve,” states Grover, “but they move and can block lymphatic channels. A contributing factor to what we term ‘pillow face’ is additionally the reality that to some extent, the face becomes somewhat fluid-filled because its capacity to remove bodily fluid has been diminished.” Though research into the topic is early-stage, cautionary statements on injectables’ potential impact on the body’s drainage have been issued, and additional studies initiated. An esteemed facial plastic surgeon, commenting anonymously, says he would never use injectables in a client because of the risks they pose. “A lot of doctors avoid talk about this, because the manufacturers who make filler can be pretty aggressive.” He’s heard stories, he adds, of plastic surgeons being landed with court orders after expressing worries.

Choice and Surgery

For Preisinger, once she started injecting filler, she felt as if she had to keep replenishing it – especially as it began moving to different areas of her face. She was just 28 when a nearby cosmetic doctor in the state proposed that a facial and neck surgery could be what she required to exit the cycle of treatments. Two years later, she ended up choosing between a selection of suggested accommodations in Istanbul, sent to her by the clinic assistant at her doctor’s clinic.

Initially, Preisinger had planned for an upper and lower blepharoplasty – better known as eyelid surgery – but her surgeon recommended that a facelift was the correct option for the looseness she was experiencing in her face. She booked a brow lift, a mid-facelift and a jawline surgery. The day before her surgery, 24 hours post she’d touched down solo in Turkey, she opted to include a lip lift. “Then he said, ‘We will lift the lower eyelid puffiness.’ He added, ‘I believe if we remove some buccal fat, it will sculpt your face.’ Thus I ultimately adding two more procedures,” she says. She paid $22,000 (£16,500) for the half-day operation, including a three-day|