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

Amanda Preisinger feels anxious about her child’s impending 13th birthday celebration. It’s not due to the usual causes associated with a house full of clamorous preteen children, but because it’s the first time she will showcase her new face to acquaintances and relatives. “Obviously I’m going to tell all guests as they come in, ‘Just so you know, this is not the way I appear,’” says the 30-year-old property agent from south Florida.

Her appearance is, admittedly, a little startling – her face swollen and unnaturally tightened, as though held together by heavy-duty tape. Her altered – and she’s eager to emphasize, temporary – look is the outcome of six cosmetic procedures, including an minimally invasive facelift, performed by a doctor in Istanbul, Turkey, the previous month. “My poor husband teared up when he saw me for the first time because I wasn’t able to even open my eyes. That indicates puffy I was,” she explains to me via video call from her home. “I needed to inform him: ‘Honey, I’m fine, I’m not in pain. I just look like someone jumped me.’”

Increasing Popularity of Early Facelifts

According to plastic surgeons, Preisinger is among a rising count of people choosing to have a rhytidectomy in their twenties and thirties – well over a decade before typical surgeons’ usual candidate age of forty to sixty. (Though most surgeons are eager to highlight the industry edict of: “We treat heredity, not years.”) “I have individuals in their late twenties asking for facelifts,” states London-based cosmetic surgeon Georgios Orfaniotis, a ex-NHS doctor who focuses on the head and neck. “It’s a very significant procedure, and I’m a bit concerned when I see individuals opting for it as a lifestyle choice.”

Understanding the Rhytidectomy Surgery

A rhytidectomy, alternatively called a facelift, elevates the tissues in the face that start to sag as we age. “Human faces are built a little like onion layers,” says Kent-based face specialist Marc Pacifico. “Dermis and adipose on the surface, then a layer of supportive tissue called the superficial musculoaponeurotic system. Think of the SMAS as the structural foundation of the face. And that’s what ages us; that is what loosens and sags and pulls the skin down with it.”

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

Previously reserved of moneyed older people, overuse of injectables – when excessive use of injectable gels expands the face and causes laxity in the skin – alongside the widespread use of slimming medications, low-cost medical tourism, and the advancement of new, celebrity-endorsed operative methods are attracting a new kind of customer towards this major operation. Reports show an 8% increase in facial lifts over the last year in the United Kingdom; while a survey found that the portion of younger facelift patients is growing, with 32% of facelifts now performed on patients aged 35-55.

“Patients are asking now to look like the optimal form of themselves and obviously the methods are following,” comments Orfaniotis. Currently, the operation du jour is the deep plane facelift, a technique evangelised by figures including Kardashian matriarch Kris Jenner, to fashion designer Marc Jacobs.

Advanced Lifting Method

Where a more traditional facelift entails lifting the superficial layer, the comprehensive lift releases the facial ligaments beneath it, enabling surgeons to restructure the face by moving the underlying layers, and avoiding the tight, stretched appearance occasionally caused by more traditional techniques. “We avoid placing tension on the dermis because we’re targeting deeper, to the underlying structures,” says Harley Street plastic surgeon Rajiv Grover, who focuses on the deep plane technique. “It is the deeper tissue that is repositioned. The dermis comes with it as a passenger.” Lifting the whole facial structure as a unified block results in a more natural-looking and more durable outcome. It also means that the surgery is no longer being used for the express purpose of youth preservation – or revitalization, as the cosmetic field describes it – but for “enhancement” and facial restructuring, too. “We’re getting many inquiries from clients aged late twenties to mid-thirties for this reason,” notes Grover.

Personal Journey

Preisinger had not intended on getting a facial lift – at least not at the thirty years old. But years of using hyaluronic acid dermal fillers in an attempt at “symmetry correction” implied that by the time she entered her late twenties, she was “damaged”. “I didn’t do this because I desired to appear young,” she says. “I underwent it because the filler ruined my face. I wish I had never done it. If I had avoided the injectable, I don’t believe I would be in this situation currently.”

Whether dermal fillers completely disappear has historically been a debated topic in the aesthetics industry. “Studies have shown that not only do they rarely completely dissolve,” states Grover, “but they migrate and can block drainage pathways. One of the contributors to what we term ‘puffy appearance’ is additionally the reality that to some extent, the face becomes somewhat waterlogged because its capacity to remove lymphatic fluid has been diminished.” Although research into the area is preliminary, warnings on dermal fillers’ potential impact on the body’s drainage have been issued, and additional studies initiated. One highly regarded facial plastic surgeon, speaking anonymously, mentioned he would avoid using injectables in a patient because of the dangers they present. “A lot of doctors avoid discussing this, because the manufacturers who make filler can be quite forceful.” He’s been told accounts, he adds, of plastic surgeons facing court orders after expressing worries.

Choice and Surgery

For Preisinger, once she started injecting filler, she believed she needed to continue adding more – particularly when it began moving to different areas of her face. She was just 28 when a nearby cosmetic doctor in Florida proposed that a face and neck lift might be what she required to exit the injectable hamster wheel. After 24 months, she ended up selecting from a selection of recommended hotels in the city, texted to her by the clinic assistant at her surgeon’s office.

Originally, Preisinger had scheduled an upper and lower blepharoplasty – better known as blepharoplasty – but her doctor advised her that a facial lift was the correct option for the looseness she was finding in her face. She arranged a brow lift, a mid-facelift and a jawline surgery. The eve of her operation, 24 hours post she’d arrived alone in the country, she opted to include a mouth enhancement. “Then he stated, ‘We will elevate the lower eyelid puffiness.’ He added, ‘I think if we remove some cheek fat, it will sculpt your face.’ So I ended up including additional procedures,” she says. She spent $22,000 (£16,500) for the six-hour operation, plus a three-day|