In what could be perceived as an apathetic eye-roll to the rising “anti anti-aging” movement, a slice of Gen X is pursuing a younger look by the most radical means imaginable—facelifts in their 40s. “Here we have this group who doesn’t want to go through the aging process,” says La Jolla, CA plastic surgeon Robert Singer, MD. They’re detouring from the timeworn path of previous generations, who either let themselves grow old, and then fought to turn back the clock in their 60s or 70s, or used liquids to stave off surgery during the dawn of injectables. (In fairness, most old-school lifts, even those from the early-’90s, left faces over-processed with sizable scars, “so folks usually waited until they looked terrible before making a move,” explains New York plastic surgeon Gerald Imber, MD.) For today’s 40-somethings, it’s more logical to hit slow-mo than rewind: “They never want to get to a point where they look like they need a facelift—where they have to undergo a dramatic change in appearance,” says New York plastic surgeon Sherrell Aston, MD. Aiming to maintain their current visage—to keep their reflections recognizable for as long as possible—they’ve adopted “a new approach to aging,” adds New York plastic surgeon Lara Devgan, MD. “They want to look better, but still the same, and having a facelift at a younger age allows that magical paradox to occur.”
The under-50 set now comprises nearly a third of Dr. Devgan’s facelift practice. Other surgeons shared similar estimates. “There is unquestionably a trend developing,” says New York facial plastic surgeon David Rosenberg, MD. “In the last week, I had 12 new facelift consults, and four were in their 40s. These women are seeing laxity that wasn’t there in their 30s, and it really bothers them.” While hardly over the hill, 40 does represent a sort of tipping point. As we inch closer to menopause during this decade, our estrogen levels begin to wane. The estrogen receptors on our fat cells and collagen-making fibroblasts, which click with the hormone to promote healthy functioning, also take a hit, resulting in a communication breakdown that translates to thin skin and volume deflation. “The fat loss first appears as sunken under-eyes, flattened cheeks and hollow temples,” explains Dallas plastic surgeon Rod J. Rohrich, MD. Our bony framework gradually shifts and shrinks, and facial muscles droop. “As the underlying foundation of the face starts to change, the cheeks slowly fall into the nasolabial folds and jawline,” says Dr. Aston. And just like that, we’ve entered facelift territory.
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While there are untold iterations of the procedure, a modern lift involves hoisting the muscles of the lower face and neck to restore the topography of youth, before trimming excess skin, and oftentimes, rounding out the restoration with a modicum of fat. Thanks to a slew of upgrades over the years, the facelift has become a routine three-hour affair delivering appreciable but natural results with generally undetectable scars and a manageable recovery period—all boons to early agers, whose relative youth breeds advantages. “The building blocks of the face are so much better at 40 than 60,” says Dr. Devgan. The skin still has some spring to it and is less likely to droop back down after surgery, whereas more mature skin tends to have “an almost taffy-like quality,” she says, stretching out when pulled tight. If the underlying tissues are in decent shape, one may qualify for a less aggressive operation, or a partial lift that tackles just the midface, say, or the neck only—all scenarios begetting less downtime and a more discreet transformation. #Goals, as they say. (Short scars and a swift rehab make mini-lifts hugely appealing, but “in certain patients, a limited approach can make one area [of the face] look imbalanced relative to others,” cautions Dr. Singer, so trust your surgeon’s judgment here.) Beyond achieving softer, more durable results, a lift in the 40s can, in a way, serve to wrinkle-proof your future face: “By taking away redundant skin, we prevent it from hanging, and forming folds and etched-in wrinkles—wrinkles that, once there, are almost impossible to get rid of,” Dr. Imber says. (Facelifts reverse laxity, not lines.)
To correct lower-face sagging, prominent jowls, and loose skin on this 48-year-old patient’s neck, New York plastic surgeon David P. Rapaport, MD performed a lower facelift. Her “after” photo was taken only two-and-a-half weeks post procedure.
Acting early clearly has its perks, but these alone aren’t driving Gen X’ers to the OR. Intrigued by the changing face of the century-old surgery, New York facial plastic surgeon Andrew Jacono, MD conducted a study on the regressing demographic. According to his findings, published in the Aesthetic Surgery Journal in 2016, more women are abandoning nonsurgical anti-aging treatments for facelifts in their early 40s. Subjects reported that devices and injectables did help them look younger—by about four years—but surgery bought them twice as much time. What women in this demo are collectively confronting, Dr. Jacono says, is more than mere filler fatigue—a tiring of the upkeep and expense of shots. Rather, our no-downtime tweaks may eventually exhaust their usefulness.
“If you have at least a centimeter of pinchable laxity at the level of the jowls, jawline or nasolabial folds, you have to acknowledge that injectables aren’t going to make that go away,” says Dr. Devgan, adding that those who overindulge by chasing folds and slack skin with a syringe “can wind up looking very clownish.” This may sound like an obligatory party line for anyone wielding a scalpel, yet most plastic surgeons will admit that needles and wands—used judiciously and early on—can absolutely help “keep the wolf from the door,” says Dr. Imber, delaying surgery for a time. But it’s important to watch for signs of their impending futility. “Once you get jowling, you’ve got to stop the fillers in the lower half of the face,” says Dr. Rohrich. Otherwise, injections become not only ineffective, but also counterproductive: “As the skin gets loose, fillers only weigh the face down,” adds Dr. Jacono. Many patients will also dabble in devices before yielding to the knife. “And all of these tools—lasers, microneedling, radio frequency—can help build up collagen, but a point comes at which they are no substitute for surgery,” notes Dr. Imber.
Troubled by drooping cheeks, loose jowls, and excessive fullness under her chin, this 40-year-old patient underwent a lower facelift and necklift with a high SMAS flap support, as well as a lower eyelid blepharoplasty, with Tijuana, MX plastic surgeon Juan Carlos Fuentes, MD.
What could be, however, at least for a select group, is the thread lift (which we explore on page 112). “In my office, the Silhouette InstaLift has nearly replaced the facelift for mild-to-moderate aging changes at 40, especially when combined with laser resurfacing of skin and volume replacement to the face,” says Chicago plastic surgeon Julius Few, MD. Also Team Thread is New York plastic surgeon Haideh Hirmand, MD, who says “threads are a really good short-term option for those in their early 40s with mild-tomoderate drooping just in the midface.” Other surgeons are skeptical: “Historically, thread lifts have been overhyped, short-lived and fraught with problems, and we’ve yet to see successful long-term results,” Dr. Singer says.
One thing experts can agree on: When the neck goes, all bets are off. “In the ’90s and before, the indication for a facelift was an aging face, but today, it’s a sagging neck,” says Vero Beach, FL plastic surgeon Alan Durkin, MD, explaining that while “injectable, laser and energy-based technologies can be incredibly effective for the face, they’re less reliable for the neck, where surgery remains the gold standard.” Indeed, once fatty jowls slip below the jaw and neck bands jut out, only surgery can create real change. Of course, not every woman under 50 feels bad about her neck; still, a fine-tuning of the platysma (the broad muscle that influences signs of aging in the neck) often comes standard with a facelift. To Dr. Devgan, “it’s the same operation, and pretty much every outcome will be improved by an angular jawline and a crisp demarcation between face and neck.”
With wind-tunnel clichés and one-for-all maneuvers now relics of nip-tucks past, we’re in an age of individualization. “This, I think, is the most significant advance in recent history,” says Dr. Singer—the newfound understanding that distinct techniques exist for different anatomies and ages. What remains universal is this: The reinvented facelift grants what no other treatment can— defined cheekbones, a clean jawline and a contoured neck. “And that,” says Dr. Rosenberg, “is beauty in the 40s.”