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Alynah J. Adams, BS1, Charlotte Thomas, BS1, Samuel J. Lin, MD, MBA1
1 Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115
Over time in aesthetic surgery, there has been a greater emphasis on overall self-care and confidence, particularly in the age of social media. The ideal age for patients to undergo any facial surgical procedure is unspecified and varies by patient, depending on multiple factors; however, most patients counseled about facial procedures are aged 40-75 years. Most patients who are interested in looking younger either are young and want to preserve their current age and appearance or want to shave a few years off their facial age.
As social media, filters, and now AI-generated images have been introduced, the definition of a ‘good’ procedure has evolved. Social media perpetuates an almost competitive need for youth and beauty in order to maintain followers and gain new ones, a more daunting task when content creators are constantly compared against unattainable AI-perfected enhancement filters. Plastic surgeons are performing the same technical procedures, with varying levels of skill, but they are no longer compared against the ‘before’ surgery look; they are compared against AI and filtered enhancements.
From Hollywood, celebrities have long influenced the beauty market, from tooth-whitening and perfume advertisements to unintentional endorsements of plastic surgery. Although new openness about facelifts in Hollywood has provided a lens into beauty standards it sets, and what is realistic, filtered, or surgical, openness about these procedures also inherently makes more patients aware of the surgeries available. However, the intervention best for an individual patient could be completely different from what their favorite model or social media influencer has done. There is little doubt that appearance can affect several aspects of an adult's life, ranging from a robust dating or social life to career or professional advantages. When a patient is interested in altering their appearance to achieve goals for external validation, it becomes more challenging to attain a satisfactory outcome. It is more realistic to achieve a more rejuvenated or replenished look, enhancing the features patients value most about their body. Ultimately, the responsibility lies with the surgeon and patient to discuss these deeply personal, technical questions about what is best for their needs.
Many patients seeking facial rejuvenation seek subtle enhancements to restore a rested, youthful appearance. However, there is a threshold at which rejuvenation transitions to transformation, when the desired changes no longer align with the patient’s natural anatomy or when multiple procedures begin to reshape, rather than refresh, the face. This shift is nuanced but significant. Counseling patients before this inflection point is essential, including discussion of the diminishing returns of excessive procedures, including the risk of surgical complications, extended recovery times, financial burden, and the potential for psychosocial distress or body image instability. I emphasize a patient-centered approach grounded in honesty, functional outcomes, and long-term well-being, guiding patients toward outcomes that enhance their confidence without compromising their appearance, safety, or mental health. People age at different rates, and the decision to undergo a facelift should depend on their needs rather than a fixed age. However, red flags a surgeon might notice include unrealistic expectations (for example, perfection), describing signs of aging that are not readily apparent, lack of understanding and consideration of risks, pressure from support persons or social media, and a documented history of severe mental health issues, including body dysmorphia and eating disorders.
A facelift, although a single surgical procedure, may involve multiple techniques. Although these techniques can have the same foundational principles, whether or not they are used, and how, is up to the individual surgeon and the patient’s needs and requests. Many surgeons support changing their technique based on the patient preference, underlying facial structure, and prior procedures. Ultimately, a facelift can be individualized to each patient. The deep-plane facelift is one type of facelift. Many misconceptions exist about deep-plane facelift, including that it is the same as a “regular” facelift, that it will create an “overdone” look, and that it is only for older patients. However, a deep-plane facelift moves tissues deeper than a typical facelift, which uses a middle layer called the “SMAS” (Superficial Musculoaponeurotic System). A deep-plane approach allows tissue movement and alteration of the structures that support the face; the final appearance will depend on the surgeon and the patient's goals. Before choosing a technique, patients should discuss with their surgeon the available techniques, which facial areas each technique addresses, and whether the technique targets the specific areas they would like to address.
There are common complications to be aware of in aggressive facelift and eye surgeries. Complications of a facelift include damage to nerves, skin, or other tissues beneath the facial layers. In eye surgeries, if too much of the surrounding eyelid structure is removed, patients may experience chronic dry eye. With proper technique, the risks of these complications can be minimized, although they may still occur. While patients should consider technique when choosing their surgeon, it is also essential to consider the credentialing of surgeons themselves. Even if the technique is appropriate for their needs, it will not work if performed by someone unable to perform the surgery correctly. Patients can verify whether their surgeon is board-certified in plastic surgery on the American Board of Plastic Surgery website. Patients should also feel empowered to ask about the surgeon’s history with this technique, including how many times they’ve performed it and what results or complications they’ve had in previous cases. Patients can ask their surgeon what complications they should expect during or after the procedure and what will be done if complications arise. They can also discuss with the surgeon how they have handled complications in the past. Additionally, patients should feel empowered to research their surgeon before any procedure, ensure the surgeon is appropriately licensed for the procedure, and review any prior legal issues the surgeon may have had.
One myth important to debunk is that facelifts are only for women. Men experience the same signs of aging, such as changes in skin quality and facial volume, as women. All components of a facelift can be modified to enhance the natural facial structure, regardless of gender. For example, a brow lift for women may be aimed at creating a more arched shape, whereas for others, the lift may be distributed more evenly across the brow. Men can, and do, undergo facelifts, and techniques are being adapted to fit their needs.
References
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- Laughter, M. R., Anderson, J. B., Maymone, M. B., & Kroumpouzos, G. (2023). Psychology of aesthetics: Beauty, social media, and body dysmorphic disorder. Clinics in Dermatology, 41(1), 28-32. https://doi.org/10.1016/j.clindermatol.2023.03.002
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