Is It Too Early For Facial Rejuvenation Surgery?
3 December 2019 onur
The ideal timing for facial rejuvenation surgery has been classically defined as the mid-50s in the plastic surgery literature. Almost all signs of facial aging have appeared in this age group, and patients gain significant visual benefits from the surgeries performed. At earlier ages, it seems that not much has changed, and at older ages, much more comprehensive combined procedures are needed to get a good result.
Facial rejuvenation surgery is not based on medical requirement but on the desire to have a younger and more beautiful face. The desire for rejuvenation does not rise in people for no reason. Each individual has their own life experience and future expectations. It is a fact that life does not treat its children fairly in any matter. Facial aging is no exception to this rule.
We can perform facial rejuvenation surgery at earlier ages than classical recommendations in the patient group where the signs of facial aging are far beyond their chronological age.
Let’s take a look at the cases where we perform facial rejuvenation surgeries at an earlier age than routine:
- The patient group with massive weight loss : There is a limit to skin elasticity. As tissues grow, the skin is stretched and adapts itself to growth. However, when tissues shrink, the skin cannot shrink together with them. It remains loose and then sags. When the abdominal and breast growth in women during pregnancy disappears after pregnancy is over, it is inevitable that these areas will sag. Similarly, people who have been involved in bodybuilding in their youth lose their muscle mass, and their skin sags. Obesity is a major health problem of our age. When we gain excess weight, the fat mass under our skin stretches the skin. They say five grams of fat hide a thousand flaws. The advancement in obesity treatment led to the emergence of a group of patients who lost massive weight. Imagine a 25-year-old man who went down from 130 kg to 65 kg surgically. When he was overweight, his facial skin grew by 1-2 sizes, and when he lost weight, it remained loose and sagged compared to the facial skeleton. The patient group with massive weight loss classically presents with facial skin laxity and sagging far beyond their age. A 30-year-old patient’s face looks like they are 45. In this group, we can also perform the surgery in 30s. We can’t tell the patient, “Well, you spend your years between 30 and 55 looking like your aunt, and I’ll operate you when you’re 55.” Around that age range, the patient is likely to experience the most active period of her life emotionally and sexually. We frequently come across a history of weight change of 20 kg or more in the 30-50 age period, when skin elasticity decreases in most of the patients who present with facial aging beyond their chronological age.
- Intense Stress: Cancer treatment, chemotherapy drugs, steroid therapy, intense work and the stress of living all cause premature aging. Look carefully at the faces of people who lost their jobs, lost their families or spouses or went through a traumatic divorce process. You will see that some of them aged by 5-10 years in a matter of 1 or 2 years. We can’t tell patients in this group, “OK, you have to curse your fate. Yes, you aged prematurely, but for surgery, let’s wait until you turn 55.” Life will go on somehow, and we will support our patients in this process.
- Spouse Mismatch: Our spouse, our partner, our beloved… We love them very much. This is love in a cottage, but people talk and we feel sad. They can’t leave lovers alone. One is 37 but looks 45. The other is 35 but looks 30. The older-looking woman says, “I’m ashamed to go and meet his parents.” The older-looking man says, “I don’t want people to say she married a man her father’s age.” In some of the patients who undergo facial rejuvenation surgery at an early age, the reason why the patient desires to have surgery is to look like a better match for their spouse. This is perfectly reasonable from my point of view. I do not tell them to grow old together and then come to me for surgery. I just do the surgery if the patient will benefit it.
- Unsuccessful past aesthetic treatments: I always tell this. All aesthetic treatments that reduce subcutaneous fat mass, cause heat damage to the skin and subcutaneous tissues as well as excessive weakening and thinning in mimic muscles may lead to early signs of aging in a group of patients. This group may turn into candidates for surgery at an earlier age due to the disappointment from non-surgical procedures.
- Early treatment option to support the face in the aging process: When facial rejuvenation surgery is performed at an early age group, a striking before-after difference does not occur because the signs of aging have not fully settled yet. It is necessary to analyze standardized before/after photos in order to realize what has changed in the face of individuals who had surgery in their early 40s. Most of the time, in social life, people hear reactions such as “Something has changed with you, but I cannot tell what it is.” Is it worth having surgery for such early facial aging or for such little change? This is a matter to discuss. However, it is a fact that since the operation will surgically support the face, gravity-related symptoms will appear later in the group of patients who have had facial rejuvenation surgery. We can describe the protective effect as follows. Imagine two sisters who are identical twins and exhibit early signs of aging. Suppose that we do a facelift in one of them at age 42 and do not operate the other. The sibling who undergoes surgery will look slightly better immediately after the surgery than the sibling who did not get operated. Since both are in the early stages of aging, there will not be a dramatic difference between them. However, if you follow up both twins until they are 55 years old, you can see that the face of the operated twin ages much better than that of the non-operated twin. Twin studies in plastic surgery provide us with information not only on the differences between operated and non-operated twins, but also on the differences between twins who both undergo surgery with different surgical techniques. We can also perform surgery at an earlier age in the patient group whose facial appearance is critical from an occupational/social point of view, thus having to maintain their facial form.
- Bone morphology prone to premature aging: The shape of the bony skeleton may differ markedly from one individual to another. Faces with prominent cheekbones and jawbones and genetically tight and strong ligaments between bone and soft tissue are more resistant to the gravitational aging process. On the contrary, in patients with underdeveloped cheekbones, cheeks droop more rapidly, and in patients with underdeveloped upper jawbone, signs of aging around the mouth appear much earlier. In patients with an underdeveloped lower jawbone, neck aging symptoms emerge at a much earlier age. In people with an underdeveloped forehead bone, eyebrows droop prematurely and impair eyelid functions. Morphological differences of the bones around the eyes affect periorbital aging and bagging as well as the anteroposterior position of the eye. For instance, some people develop under-eye bags at the age of 14-15. If the bone morphology is prone to premature aging, surgical procedures may be needed for rejuvenation at an early age. In such patients, we can unconventionally place prostheses (implants) on the bone surface in addition to facelift surgery.
- Connective tissue diseases: Some genetic and acquired connective tissue diseases may cause the face to age very significantly at a very early age. In the treatment of such diseases, surgical correction procedures may be required at an early age. Some people have mild forms of the genetic disorders that underlie these diseases. The patient looks older than all their peers, but they do not have a clearly diagnosed connective tissue disease. In such cases described as “intermediate forms”, it may be required to perform rejuvenation surgeries at an earlier age.
- Endoscopic and minimally-invasive surgical approaches: The emergence of surgical procedures that leave shorter and rather hidden scars has made facial rejuvenation procedures accessible to a younger group of patients. These procedures are not as effective as conventional surgeries, but the young patient group often does not need the effectiveness of conventional surgeries. We use endoscopic facial aesthetics, mostly in combination with resurfacing treatment and adipose tissue transfer, in the early aging period when the skin does not sag yet but the soft tissue distribution disorder has been growing evident. This is an appropriate treatment approach, particularly in female patients between the ages of 35-45.
If you feel that the appearance of your face is incompatible with your chronological age,
If you are undecided about the right timing for facial rejuvenation surgery,
If you would like to discuss current treatment options or set a long-term strategy,
Feel free to contact us.
Take good care…
… of yourself and your beauty.