With the 2020s well underway, things are starting to feel a little futuristic, especially in the world of cosmetic treatment and procedures. What once was science fiction is now fully attainable: lasers can erase our sun damage without significant damage, stem cells and exosomes can regenerate our skin cells, and surgical procedures have refined to highlight natural-looking results that are nearly undetectable. Even procedures we consider household names, like the facelift, have undergone multiple evolutions as techniques refine and patient interest widens.
For Houston, TX plastic surgeon Henry Mentz, MD, that’s meant staying at the cutting edge of facelift methodology to provide for his rapidly shifting clientele of patients. “We have definitely seen momentum toward younger facelift patients,” Dr. Mentz says. “Back in the year 2000 most patients were between 60 and 75 having facelifts. Our average age now is in the low 50s and starting to trend toward the mid-40s.”
The Changing Face of Facelifts
While patients interested in plastic surgery have been consistently trending younger and younger for some time, COVID made the shift very apparent.
“Younger patients have gained momentum because of COVID and people spending a lot of time at home, in virtual meetings, and with spouses,” Dr. Mentz says. “This has given many patients the opportunity to make changes and recover more discreetly.”
Those patients in their mid-40s are typically familiar with cosmetic rejuvenation and ready to take a step up from noninvasive treatments to get the results they want.
“Many patients in their mid 40s are coming in because they’re beginning to see changes in the descent or sag of soft tissue in the midface, more wrinkles, and extra skin around the eyes,” Dr. Mentz explains. “Typically, these are patients who invested the last 20 years in Botox and fillers and are realizing they’ve spent more or as much already to make a commitment to look 10 years younger.”
Still, patients for facelifts have gotten younger than even their 40s.
The Ozempic Effect
“Another reason for younger facelift patients is that everyone is jumping on the Ozempic, Wegovy, ‘Skinny shot’ train,” Dr. Mentz says. “Since the weight loss is relatively rapid, the structures of the skin and deep facial tissues do not have time to restructure and shrink, leaving the overlying tissue and skin with increased laxity, volume loss, and more wrinkles.”
To meet the needs of younger facelift patients, the surgery itself had to be modified.
“The scars from incisions are made more discreetly,” Dr. Mentz explains. “The changes in hairline are much less obvious, as well. The faces of the 80s and 90s were dependent more on skin tension, whereas now we can create a softer and less-surgical look.”
The Texas Jawline
Facelifts are also now often combined with nonsurgical options to achieve a complete and balanced outcome. Among Dr. Mentz’s arsenal of facelift techniques is one that can be completed via surgical or nonsurgical means: the Texas Jawline.
“This cosmetic procedure is aimed at enhancing the appearance of the jawline, inspired by the beauty standards associated with the state of Texas in the United States,” Dr. Mentz says.
The term originated overseas in Europe and the Middle East, where it meant described a sharp, angular jaw. Using methods like dermal fillers, a Texas Jawline can be created without surgery, but combining it with a facelift can create a more long-term option.
“For a more permanent Texas Jawline, a facelift can be performed,” Dr. Mentz explains. “During the facelift, excess skin and tissue are removed, giving more strength to the cervical mandibular groove. The SMAS layer, or superficial musculoaponeurotic system of tissue located beneath the skin and superficial fat layer, is folded over to create a more defined jawline. In combination with the facelift, I use fat-grafting along the jawline resulting in the perfect Texas Jawline.”
Virtual Visualization
With the advent of new technology in the office, more patients are also able to try on their surgical results using 3-D imaging. The ability to test out results has brought in patients that may otherwise be overwhelmed, be uninterested in cosmetic investment or unsure where to start.
“Most of these patients in their 40s and 50s really haven’t thought much about the surgery procedures but are really just interested in how they might look and what procedures are options,” Dr. Mentz says. “So the most important strategy for these patients is to have long discussions about their goals and also to do 3-D analysis of their face with different adjustments to show them what it means have some laser or some of these soft tissue–lifting devices like FaceTite, Morpheus and Sofwave and the differences between that and actual surgery like deep plane facelift, necklift or eyelift procedures.”
Patients in their 40s and 50s may also require a combination of modalities to address all their concerns, and 3-D imaging can show them exactly what treatment targets which parts of aging.
“Sometimes patients expect too much from fillers and Botox,” Dr. Mentz says. “Sometimes patients are looking for a nonsurgical option that provides a surgical-like result, and there’s not one. Most of our Medispa procedures and devices can provide a two- or three-year improvement but not a 10-year improvement like a facelift can.”
