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

Amanda Preisinger experiences worry about her daughter’s upcoming 13th birthday celebration. Not for the usual reasons related to a house full of clamorous preteen kids, but since it’s the first time she will showcase her new face to friends and relatives. “Obviously I’m going to inform everyone as they arrive, ‘Just so you know, this is not the way I look,’” states the thirty-year-old property agent from Southern Florida.

How she looks is, admittedly, a somewhat startling – her face puffed up and preternaturally lifted, as though held together by industrial-grade tape. Her new – and she’s eager to emphasize, short-term – appearance is the result of half a dozen cosmetic procedures, including an endoscopic mid-facelift, conducted by a doctor in Turkey’s Istanbul, last month. “My spouse teared up when he viewed 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 house. “I needed to inform him: ‘Honey, I’m okay, I’m not in pain. I just appear as if someone attacked me.’”

Increasing Popularity of Youthful Facial Lifts

According to plastic surgeons, Preisinger is one of a growing number of people choosing to undergo a rhytidectomy in their 20s and 30s – well over a ten years before typical surgeons’ usual candidate age of 40 to 60. (Though most surgeons are keen to emphasise the professional guideline of: “We treat heredity, not years.”) “I have individuals in their late twenties asking for facial lifts,” states London-based aesthetic plastic surgeon Georgios Orfaniotis, a ex-NHS doctor who specialises in the facial area. “It’s a very significant surgery, and I’m a bit concerned when I see individuals choosing it as a personal preference.”

Understanding the Rhytidectomy Surgery

A rhytidectomy, alternatively called a facelift, lifts the tissues in the face that begin to droop as we age. “Our faces are structured a little like layers of an onion,” says Kent-based facial plastic surgeon Marc Pacifico. “Dermis and adipose on the top, then a stratum of supportive tissue called the superficial musculoaponeurotic system. Consider the SMAS as the structural foundation of the face. And that is what ages us; that is what becomes lax and drags the dermis down with it.”

You endanger operating on people that have underlying problems. It’s not advisable for an conscientious surgeon to follow

Previously reserved of moneyed older people, overuse of injectables – when overuse of dermal fillers stretches the face and leads to looseness in the dermis – combined with the common adoption of weight-loss drugs, low-cost medical tourism, and the advancement of new, famous-figure-promoted operative methods are attracting a different type of patient towards this major operation. Reports indicate an eight percent rise in facelifts over the past 12 months in the United Kingdom; while a survey found that the percentage of youthful candidates is growing, with one-third of procedures now conducted for individuals aged 35-55.

“Patients are now requesting to appear as 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 promoted by figures including reality TV star Kris Jenner, to fashion designer Marc Jacobs.

Deep Plane Technique

Where a conventional rhytidectomy involves elevating the superficial layer, the comprehensive lift loosens the underlying structures underneath, enabling doctors to restructure the face by repositioning the underlying layers, and avoiding the taut, pulled appearance sometimes wrought by older methods. “We avoid placing tension on the skin because we’re targeting deeper, to the underlying structures,” explains Harley Street plastic surgeon Rajiv Grover, who specialises in the deep plane technique. “It is the underlying layers that is adjusted. The skin follows along as a passenger.” Lifting the entire soft tissue layer as a single unit allows for a more natural-looking and longer-lasting outcome. It also means that the procedure is not just being used for the primary goal of youth preservation – or rejuvenation, as the cosmetic field terms it – but for “enhancement” and facial restructuring, too. “We’re getting many inquiries from patients aged late twenties to mid-thirties for this purpose,” notes Grover.

Personal Journey

Preisinger had not intended on getting a facial lift – at minimum not at the thirty years old. But long-term using hyaluronic acid dermal fillers in an attempt at “symmetry correction” meant that by the time she entered her late twenties, she was “damaged”. “I didn’t do this because I desired to appear youthful,” she says. “I did it because the filler harmed my face. I regret ever using it. If I had avoided the filler, I don’t believe I would be in this situation right now.”

Whether dermal fillers ever fully dissolve has long been a debated topic in the cosmetic field. “Studies have shown that they seldom fully dissipate,” says Grover, “but they migrate and can block lymphatic channels. A contributing factor to what we call ‘puffy appearance’ is also the reality that in a sense, the face gets slightly fluid-filled because its ability to drain lymphatic fluid has been diminished.” Though research into the topic is preliminary, cautionary statements on injectables’ possible effects on the lymphatic system have been released, and additional studies initiated. One highly regarded face specialist, speaking on the condition of anonymity, mentioned he would avoid using fillers in a client because of the dangers they pose. “A lot of doctors don’t want to talk about this, because the companies who produce injectables can be pretty aggressive.” He’s been told accounts, he says, of cosmetic doctors facing legal actions after raising their concerns.

Choice and Surgery

For Preisinger, after beginning injecting filler, she felt as if she needed to continue replenishing it – particularly when it started to migrate to different areas of her face. She was just 28 when a local plastic surgeon in Florida suggested that a facial and neck surgery might be what she needed to exit the cycle of treatments. 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 upper and lower blepharoplasty – better known as blepharoplasty – but her doctor recommended that a facelift 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, one day after she’d touched down solo in Turkey, she decided to add a lip lift. “Then he said, ‘We’re going to lift the lower eyelid puffiness.’ Then he said, ‘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 (sixteen thousand five hundred pounds) for the six-hour operation, including a three-day|