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

Onemanda Preisinger is nervous about her child’s impending 13th birthday celebration. It’s not due to the usual causes associated with a house full of clamorous adolescent children, but since it’s the first time she will debut her new face to friends and extended family. “Clearly I’m going to tell everyone as they arrive, ‘Just so you know, this is not how I look,’” states the 30-year-old real estate agent from Southern Florida.

Her appearance is, well, a somewhat startling – her face swollen and preternaturally lifted, as though held together by heavy-duty tape. Her new – and she’s keen to stress, temporary – look is the result of half a dozen aesthetic surgeries, including an minimally invasive facelift, conducted by a surgeon in Turkey’s Istanbul, the previous month. “My spouse became emotional when he viewed me for the initial time because I couldn’t even open my eyes. That indicates puffy I was,” she explains to me via video call from her home. “I had to tell him: ‘Honey, I’m okay, I’m not hurting. I just appear as if someone attacked me.’”

Growing Trend of Youthful Facial Lifts

According to cosmetic specialists, Preisinger is one of a growing number of people choosing to undergo a rhytidectomy in their twenties and thirties – significantly before a ten years prior to most doctors’ typical patient age range of 40 to 60. (Although most surgeons are keen to emphasise the industry edict of: “We treat heredity, not years.”) “I have individuals in their late twenties requesting facial lifts,” says London-based aesthetic plastic surgeon Georgios Orfaniotis, a former NHS consultant who focuses on the head and neck. “It’s a very significant procedure, and I’m a bit concerned when I observe individuals choosing it as a lifestyle choice.”

Explaining the Rhytidectomy Surgery

A facelift, alternatively called a rhytidectomy, lifts the tissues in the face that start to sag as we age. “Our faces are structured a little like layers of an onion,” says based in Kent facial plastic surgeon Marc Pacifico. “Dermis and adipose on the surface, then a stratum of supportive tissue called the SMAS. Consider the SMAS as the soft tissue skeleton of the face. And that is what ages us; that is what becomes lax and drags the dermis downward 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 overuse of dermal fillers expands the face and leads to laxity in the dermis – alongside the widespread use of weight-loss drugs, low-cost medical tourism, and the development of novel, famous-figure-promoted surgical techniques are driving a different type of customer towards this major operation. Statistics show an eight percent rise in facelifts over the past 12 months in the UK; while a study found that the portion of younger facelift patients is growing, with 32% of facelifts now performed on individuals aged 35-55.

“People are now requesting to appear as the optimal form of themselves and obviously the techniques are evolving,” comments Orfaniotis. Currently, the operation du jour is the comprehensive facial lift, a method evangelised by figures including reality TV star Kris Jenner, to fashion designer Marc Jacobs.

Deep Plane Technique

Where a conventional rhytidectomy involves lifting the SMAS, the deep plane facelift releases the facial ligaments underneath, enabling doctors to restructure the face by moving the underlying layers, and avoiding the tight, stretched appearance occasionally caused by more traditional techniques. “We’re not putting tension on the dermis because we’re targeting deeper, to the deeper tissue,” 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 unified block allows for a more natural-looking and more durable outcome. It additionally implies that the procedure is no longer being used for the express purpose of youth preservation – or rejuvenation, as the cosmetic field describes it – but for “beautification” and facial restructuring, too. “We’re getting numerous requests from patients aged late twenties to mid-thirties for this reason,” says Grover.

Personal Journey

Preisinger had not intended on getting a facelift – at least not at the age of 30. But years of using injectable gels in an effort at “symmetry correction” meant that by the time she reached her late 20s, she was “damaged”. “I didn’t do this because I wanted to look young,” she clarifies. “I underwent it because the injectable harmed my face. I wish I had never using it. If I didn’t have the injectable, I don’t believe I would be where I’m at right now.”

If dermal fillers ever fully dissolve 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. One of the contributors to what we call ‘puffy appearance’ is also the reality that in a sense, the face gets somewhat waterlogged because its ability to remove lymphatic fluid has been diminished.” Although studies into the topic is early-stage, warnings on dermal fillers’ potential impact on the body’s drainage have been issued, and further research announced. One highly regarded facial plastic surgeon, commenting on the condition of anonymity, mentioned he would never use fillers 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 cosmetic doctors facing legal actions after raising their concerns.

Choice and Surgery

For Preisinger, after beginning injecting filler, she believed she needed to continue replenishing it – especially as it started to migrate to other parts of her face. She was just 28 when a local plastic surgeon in Florida proposed that a facial and neck surgery might be what she needed to finally step off the cycle of treatments. Two years later, she found herself choosing between a list of recommended hotels in Istanbul, sent to her by the patient coordinator at her doctor’s clinic.

Initially, Preisinger had planned for an upper and lower blepharoplasty – better known as blepharoplasty – but her surgeon recommended that a facelift was the correct option for the looseness she was finding in her face. She booked a brow lift, a mid-facelift and a neck lift. The eve of her surgery, one day after she’d arrived alone in the country, 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 recalls. She spent $22,000 (£16,500) for the six-hour operation, including a three-day|