Many people are not sure when the best age is to pursue a facelift procedure. Once you start noticing signs of aging, the decision to seek a minimally invasive procedure or surgery becomes challenging. With this article, Dr. Thomassen presents his observations on what the best age is for a facelift or other surgical interventions.
Apparent Age vs Chronological Age
Every individual experiences signs of aging at different times in their lives. Due to the effects of genetics, lifestyle, medications, and environmental exposure, people will experience aging severity differently. For this reason it may be better to focus on apparent age and not necessarily chronological age when making a decision to rejuvenate. Nonetheless, it is useful to use a chronological guide to help summarize goals and treatments.
Thirties
Some women in their thirties inquire about plastic surgery for facial rejuvenation. Although this is rare and it may represent a troubling trend based on the societal pressurs from social media, there are instances where this is bona fide concern.
Weight Loss
The first is extreme weight loss after gastric bypass procedures or more commonly GLP-1 receptor agonist treatments. Weight loss affects all our body but changes can be dramatic in the face, including loss of cheek fullness, deep nasolabial folds, and obtuse neck angles. In young patients that have lost significant weight in excess of 30 lbs, these changes can be dramatic and can significantly affect the youthfulness of their faces.
Procedures in this Age Group
The surgical corrections needed in this age group consist of mini lifts or lateral temporal lifts to lift the cheeks and efface nasolabial folds. Because more youthful skin still retains some elasticity and thickness, only small excisions can result in significant improvements and this allows the use of smaller incisions and therefore smaller scars.
Another common concern in this age group is fat pad herniation of the lower eyelid resulting in eyelid bags. These are not necessarily unnatractive, but it may result in a tired look that younger patients may want to address. Luckily the correction does not involve any scars as the procedure is done from inside the eyelid to remove the offending fat.
Fourties
At this age some signs of aging are are advancing but still not significantly. Lifestyle factors affect the severity of these signs including sun exposure, weight fluctuations, and toxin exposure like smoking, vaping, and alcohol. So an important recommendation is to take care of your body to delay signs of aging as much as possible.
Nonetheless at this age, cheek descent with deepening nasolabial folds maybe more visible. Also a small amount of skin excess or wrinkle in the neck may become apparent. Procedures at this stage of life are usually considered more preventative or maintenance procedures.
Procedures in this Age Group
Usual procedures in this age group are again, mini lifts with short scars and temporal lifts.
In addition to lower lid blepharoplasty for fat herniation, excess upper lid skin can start to become apparent and a simple upper eyelid blepharoplasty is a very nice, long-term correction for this. This makes the combination of a mini facelift and upper lid blepharoplasty very common in this age group.
Pros and Cons
One benefit of early plastic surgery in this age group is that smaller procedures are very effective, again due to the elasticity of the skin, and scars are much smaller and less conspicuous. Another benefit is that we heal much faster at a younger age with with resolution of scars occuring much quicker. In some patients, full healing is seen in 7-10 days. Still another advantage is that the results are subtle so there is less of an extreme change in appearance than would be expected if performed at a later stage in life. This means that return to social activities can occur earlier.
One caveat about pursuing surgery at this age is that secondary procedure may be needed 10 to 15 years in the future to restore the benefits lost by further aging. However, these secondary procedures are usually less aggressive since the prior surgery avoided excessive aging changes.
Finally, according to Owsley et al(1), procedures performed in this early age group maintained their youthful appearance for longer than older cohorts.
Bottom Line
The benefit of acting before advance signs of aging appear are decreased downtime, decreased risk, faster recovery, natural results, and maximal longevity of results. These are considered more maintenance or preventative procedures.
Fifties
This would have to be the more standard decade when patients seek plastic surgery. Changes in aging are more remarkable including loss of facial fat and volume, deeper nasolabial folds, jowl formation, and neck bands.
Common Procedures in this Age Group
In this age group a full facelift is more common involving the tightening of neck muscles and removal of neck fullness by removing fat and tightening muscles. Therefore the trend is to be a bit more aggressive surgically to address the more visible signs of aging.
Brow lifts are more of a consideration due to gradual descent of the tail of the brow becoming more apparent. A common combination of procedures in this age group is therefore a face and neck lift, eyelid lift and brow lift.
Bottom Line
Benefits of surgery in this decade include continued health in most patients making for quick recoveries from surgery and healing inside of 2 weeks.
Patients have high satisfaction rates with results in this age group with natural results. There is a slightly longer recovery, slightly less longevity of results.
Sixties
In this age group, aging has affected the facial areas already discussed. In addition, the skin quality has been affected with age, leading to decreased elasticity and thickness. This in turn leads to fine wrinkles around the mouth and eyes. For this reason, skin resurfacing is commonly used in this decade to address these fine wrinkles. Either chemical peels or lasers are used to address this.
Common Procedures in this Age Group
Loss of volume in the face with more visible tear troughs, temple hollows, loss of lip volume, and submalar hollows is more apparent at this age. For this reason, fat grafting is used to restore this loss volume.
A common combination of procedures in this stage includes a face and neck lift, eyelid lift, eyebrow lift, fat grafting, and chemical peel or laser resurfacing.
Pros and Cons
Recovery in this age group is not as robust as in earlier decades so patients need to allow a full 3 weeks for full healing and swelling resolution. Postop care following Dr. Thomassen’s instructions carefully will help reduce healing time.
Although the results do not last as long in this age group, there is high satisfaction with the results.
Bottom line
Patients in this age group exhibit a high satisfaction rate with results but with less longevity of results and longer downtime. Need for additional modalities like skin resurfacing and volume replacement are frequently needed.
Seventies and Eighties
Most patients that seek a rejuvenation procedure have had prior treatments of different magnitudes. Many times procedures in these patients are not as involved since prior procedures took care of more visible aging changes.
In addition, patients in this age group may not want an aggressive procedure due to concerns regarding risks and prolonged recovery. Their priorities are to look good but recovery quickly to get back to enjoying life sooner.
However, if a patient in this age group has not had any procedures previously, there may be significant aging changes that require a robust procedure to address. For example, significant jowl fullness due to radial expansion of the face with aging will not be adequately addressed with some less aggressive procedures on the face.
The neck can be addressed without doing a submental dissection and platysmaplasty by addressing it from only the lateral approach. This makes recovery much quicker for these patients.
For these reasons, less extensive procedures become more popular in older aged patients that want a recovery. A common combination is a deep plane mini facelift that although it does address the significant jowl fullness and deep nasolabial folds, it allows for a quicker less involved recovery.
One drawback of starting the rejuvenation process in this stage is that results may not be as long lasting. I addition, healing is delayed and recovery can be longer, more in the order of 3 weeks than 1 week.
Owsley et al(1) also noted that while appearance remained better than untreated peers, there was noticeable regression of results.
Bottom Line
There are still high patient satisfaction rates in this cohort because patients see initial dramatic improvements. However, they will experience poorer long-term retention. Prolonged recovery in these older cohorts is seen, therefore less extensive procedures lead to high satisfaction and quick recoveries for earlier return to social activities.
References
- Long-Term Results of Face Lift Surgery: Patient Photographs Compared with Patient Satisfaction Ratings. Liu, Tom S. M.D., M.B.A.; Owsley, John Q. M.D. Plastic and Reconstructive Surgery 129(1):p 253-262, January 2012.
- American Society of Plastic Surgeons. How Fat Loss Accelerates Facial Aging.