For decades, the facelift was seen as a rite of passage for those seeking to turn back the clock, an invasive secret shared only behind closed doors. Today, however, the narrative around facelifts is shifting dramatically. Cannes Film Festival was buzzing with rumours of Brad Pitt’s sudden rejuvenation and snatch jawline. Demi Moore’s Body Horror film The Substance explored the dark side of a youth obsessed culture and had an 8 minute standing ovation. The VMA’s were followed with countless Tik Tok creators breaking down the changes in Taylor Swift’s cheekbones and facial structure wondering if she’s had time to visit a discrete surgeon for fat grafting, an upper blepharoplasty or some even suggested a ponytail facelift.
But this curiosity and surge of treatment is not confined to celebrity culture. With a growing emphasis on regenerative medicine, and advancements in cosmetic surgery techniques, an increasing number of people as young as in their 30s, 40s, are opting for surgical and augmented facial rejuvenation procedures. What’s more, they’re openly discussing the various surgical and non-surgical techniques available. But what exactly does it mean to “go under the knife” in this new era of aesthetic enhancement?
I experienced two real life consultations and followed the yellow brick road of the promise of youth to the offices of two leading surgeons in Sydney. Dr Michael Zacharia, a Sydney Ear Nose and Throat surgeon, and Dr Amira Sanki, a Specialist Plastic Surgeon and former Vice President and Chair of Education of the Australasian Society for Aesthetic Plastic Surgeons . I also spoke with Surgical Nurse David Watermayer, and post recovery specialist Shannon Chandler , to uncover the world of facelift procedures, the different procedures available, and the reality of what patients can expect before, during, and after surgery.
The Growing Demand for Facelifts: Who’s Getting Them and Why?
“I recently had a 32-year-old patient come in wanting to have a facelift,” Dr Michael Zacharia revealed. “She had previously had fillers to the cheeks, mid-face, lips, and Botox but decided she didn’t want anything anymore. She had some of it dissolved and let the rest dissipate over time.” This story isn’t an anomaly, as Zacharia notes that he’s seeing more patients seeking facelifts at younger ages than ever before.
The interest in surgical facial rejuvenation stems from a desire for long-term results that non-invasive treatments can’t always deliver. Dr Amira Sanki, who specialises in facelifts for patients of varying ages, finds the concept of a “preventative facelift” puzzling. “I don’t understand this concept of a preventative facelift. It’s one of the most ridiculous things ever because why would you deliberately take on the risks of surgery to prevent ageing? Surgery should always be about actually treating a problem,” Dr Sanki asserts.
According to her, surgery should only be considered once patients start seeing signs of true skin sagging and fat descent, not as a means to ward off ageing before it begins.
Dr Sanki also highlighted a new trend driving younger patients to seek facelifts: “Ozempic face” and significant weight loss. “I see a lot of ‘Ozempic face,’ especially among those who’ve had significant weight loss or bariatric surgery. The issue is that sudden weight loss leads to rapid fat loss, which creates hollowness in the face and causes the skin to sag,” she explained. This rapid loss of facial volume can make individuals look older, even if they’re younger, prompting them to consider surgical solutions to restore lost fullness.
Dr. Zacharia attributes this trend to dissatisfaction with temporary solutions like fillers and non-surgical treatments. “Patients are seeking long-term results. They’re tired of the cycle of fillers and are looking for something more permanent,” he says.
Psychological readiness is also crucial. Dr. Tim Edwards, Former President of ASAPS, highlights that mental health issues like anxiety or unrealistic expectations can hinder a patient’s satisfaction post-surgery. To improve outcomes, the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) introduced a psychological screening tool to assess patients’ mental health and ensure they are well-prepared for the emotional demands of surgery. This tool helps reduce the risks of dissatisfaction that may stem from mental health challenges, helping patients navigate the psychological complexities of their transformation safely
The Anatomy of a Facelift: Techniques and Options
Facelift procedures have evolved, offering various techniques tailored to individual needs. Dr. Sanki emphasises the importance of understanding facial anatomy in choosing the right approach. “The layers of the face include the skin, the fine layer of subcutaneous fat, and the SMAS—the muscle layer that holds all the facial muscles together,” she explains. “The key to any facelift is picking up that fat and putting it back in the right place.”
Here’s a breakdown of the most common techniques:
SMAS Facelift: The SMAS (superficial musculoaponeurotic system) facelift focuses on lifting and tightening the SMAS layer, which supports the muscles of the lower face. “By tightening the SMAS, we can address sagging cheeks, jowls, and prominent nasolabial folds,” Dr. Sanki explains. This procedure repositions the facial fat and soft tissues to restore youthful contours. The SMAS technique is known for providing natural-looking results with relatively longer-lasting effects, especially in the lower face and neck.
“The SMAS technique allows us to reposition the fat and soft tissues, which is why it gives such a natural result. It’s not just about tightening the skin—it’s about lifting the underlying structure.”
Deep Plane Facelift: Considered one of the most advanced and effective techniques, the deep plane facelift goes beyond the SMAS by addressing deeper layers of facial tissue. “In a deep plane facelift, we lift the skin around four centimetres in front of the face and go into the deeper tissue, keeping it attached to the skin,” says Dr. Zacharia. “This method maintains the quality of the skin, prevents that stretched look, and results in scars that are almost imperceptible.” The deep plane facelift is particularly effective for patients with significant sagging and who want to address both the mid and lower face, providing a more comprehensive rejuvenation.
“It’s a much stronger pull to the deep plane of the lower face and the neck as well. To lift the neck, you need to lift the jaw and the lower face. And to lift the lower face, quite often, you need to lift the brow because everything is moving up in a vertical manner. That’s the only way you can get the neck right.”
Ponytail Lift: Ideal for younger patients with minimal sagging, the ponytail lift offers a somewhat less invasive option. “The ponytail lift involves lifting the brow and midface through tiny incisions behind the hairline,” says Dr. Zacharia. “It’s what we call a scarless facelift.” This technique coined by Dr Chachi Kao in Los Angeles can change the look of the face quite dramatically.. This procedure involves tiny incisions behind the hairline and is marketed as a “scarless” option, making it an appealing choice for younger candidates with good skin elasticity and minimal sagging. “Someone like yourself, who has good skin and not a lot of sagging or jowling, could be a candidate for this procedure,” he advised during our consultation.
Conversely, he also advised that I may not like this option if I don’t want to significantly change my appearance, particularly around my eyes. “Sometimes you have to lift the brow quite significantly, so it can change the shape of your brow. To get access and lift the mid-face, you really need to lift the brow so that everything lifts together. The only issue is that sometimes it can change the shape of your brow. Someone like yourself, for example, you wouldn’t want your brow lifted too much because it’s in a nice position. You don’t want it to look like you’ve had a lift there.”
Fat Grafting: Restoring Lost Volume
Facelifts don’t just involve lifting and tightening; in many cases, surgeons also use fat grafting to restore volume lost with age. Dr. Sanki is an advocate of fat grafting to complement facelifts. “When we perform facelifts, we’re often repositioning fat into its original place,” she explains. “A youthful face isn’t just lifted; it’s also fuller, especially in the mid-face.”
Dr. Zacharia agrees, noting that fat grafting can be used during or after a facelift to achieve a more natural look. “Fat grafting is great because you’re using the patient’s own fat, and it can last longer than fillers. You can also place fat in areas where volume loss is significant, such as the cheeks or temples,” he says.
Fat grafting not only restores lost volume but also improves skin quality, as the fat contains stem cells that promote regeneration. “I always do fat grafting conservatively,” Dr. Zacharia adds. “The last thing you want is to overfill, as it’s harder to remove fat than filler.”
Stem Cell Technology: Pioneering the Future of Facial Rejuvenation
For those interested in the cutting edge of aesthetic innovation, Dr Zacharia’s work with stem cell technology offers a glimpse into the future of facial rejuvenation. “I’ve just started a new stem cell business called ‘Stem Mortal,’” Dr Zacharia revealed. “When people undergo procedures like liposuction or tummy tucks, the fat is usually discarded. But now, we’re taking that fat, processing it in a laboratory, and creating stem cells that can be used for rejuvenation.” While still in its early stages, this groundbreaking approach holds promise for more natural and long-lasting facial rejuvenation options.
Contraindications and Adjacent Therapies: Navigating the Do’s and Don’ts
Both surgeons highlight concerns over prior non-surgical treatments impacting surgical outcomes. “When you’re doing the surgery, you’re coming across either the threads that haven’t dissolved or scar tissue where energy-based devices or fillers have been used,” says Dr. Zacharia. “It makes life harder for us.”
Dr. Sanki adds, “Threads are a real pain for us when we do a facelift because we have to cut through that scar tissue that the threads create.” She also discusses the lingering presence of fillers. “We do see [fillers] when we get in there. It sits like blobs of hyaluronic acid gel wherever it’s been injected,” she notes. “I think [fillers] do completely dissolve, but the scar tissue or changes in the lymphatics that it’s creating might stay forever.”
Energy-based treatments like lasers and ultrasound devices also pose risks. “We would warn patients who have had a lot of heat-based treatments that we’re at higher risk of the skin flap in the facelift surgery having a compromised blood supply,” Dr. Sanki cautions. “I would be a little bit worried, even with an abdominoplasty, if someone’s had a lot of heat-based skin tightening treatments.”
Preparing for Surgery: What to Do and What to Avoid
Preparation is crucial for optimal surgical outcomes. “Ideally, patients should lay off the hyaluronic acid fillers and threads before surgery,” advises Dr. Sanki. “It would be great to meet your surgeon a few months out for surgery in a natural state so they can assess what you’re trying to achieve with tox and fillers.”
Dr. Zacharia emphasises skin quality. “The better your skin quality, the longer-lasting the result,” he says. He recommends treatments like EMFACE, a device combining radiofrequency and electrical stimulation, to improve skin laxity and revitalise the muscles ahead of surgery. “Doing EMFACE after a facelift can also help to maintain and lift.”
However, timing is key. “All those things that you’re doing to your face along the way are going to be beneficial,” he notes, but suggests coordinating with your surgeon on the timing of such treatments.
Surgical nurse David Watermayer underscores the importance of health and lifestyle factors. “We don’t recommend going on any sort of Mediterranean diet that could thin your blood before surgery, as this can affect the healing process,” he says. “Also, for women over 45, skin treatments can help prepare the skin before surgery.”
The Journey of Recovery: Support Beyond the Operating Room
Post-operative care is as significant as the surgery itself. Shannon Chandler, a post-op recovery specialist, focuses on both the physical and mental aspects of healing. “I love pre-opping patients the day before surgery because if I can take fear out before it actually kicks in, their whole recovery is better,” she says. “It’s about working with their tissue and their lymphatic system, but also with their mind.”
Chandler collaborates closely with surgeons to ensure a seamless recovery. “I work out very clearly what each individual surgeon wants patients to do or not do, how they want them to sleep, and I’m constantly reiterating that message,” she explains.
The initial days post-surgery are centred on managing swelling. “In the first 10 days or so, it’s all about swelling, but then it’s actually about using techniques to integrate that tissue back in whilst protecting the integrity of what the surgeon has done,” says Chandler.
She also addresses the emotional challenges patients face. “You’ve spent a small fortune for the privilege, and you’re a little bit black and blue; your iPhone might not recognize you,” she empathises. “It can be really strange. Your face is a little bit numb; it can feel quite woody.”
Watermayer provides insight into the recovery timeline. “Between weeks six and three months, that tight feeling in your face will begin to ease gradually,” he explains. “By the three-month mark, you should feel back to your normal self again.”
Informed Decisions for Better Results
The consensus among these experts is clear: personalised care and informed decisions are paramount. “Facial surgery is not a one-size-fits-all solution,” asserts Dr. Sanki. “Do it when you have jowls, when you have a prominent nasolabial fold, when you can see a big difference by lifting. That’s when surgery is going to do something for you.”
Both surgeons agree on the importance of avoiding overuse of non-surgical treatments that might complicate future surgeries. “Everything works well together, and I would do a little bit of everything,” says Dr. Sanki. “But I wouldn’t have a facelift every five years.”
As for the trend of younger patients seeking facelifts, Dr. Sanki remains cautious. “If you have a facelift when you are younger, in your 40s, I would almost guarantee that you’re going to have another one in your lifetime, probably in your late 50s,” she notes.
Ultimately, the modern facelift is less about chasing eternal youth and more about restoring confidence and harmony to one’s appearance. With advancements in techniques and a deeper understanding of facial anatomy, achieving natural, lasting results is more attainable than ever—provided one takes the time to prepare, chooses the right surgeon, and approaches the journey with both eyes open.
“If you’re going to have a facelift, make sure it’s for the right reasons and done by someone who understands the anatomy of your face,” advises Dr Sanki.
This experience and these conversations, surprisingly, led me down a renewed commitment to the non surgical path. I am pleased to have learned more about the procedures, risk and options and assess my own readiness for surgical options. I found ultimately that I aligned with Dr Amira Sanki’s view that preventative surgery is heavy handed and something I am not ready for.
Self advocacy and Learn More
If you are considering surgery, please visit https://aestheticplasticsurgeons.org.au/ to learn more about the procedure, download helpful guides and ensure your surgeon is correctly qualified to perform the procedure.
New AHPRA Regulations for Cosmetic Surgery became effective July 1st 2023.
- A General Practitioner referral will be mandatory for ALL patients having a consultation for cosmetic surgery
- A mandatory two (2) consultations are required for cosmetic surgery
- There will be a patient pre-screening assessment test (PAT) for Body Dysmorphic Disorder and other underlying psychological issues
- A cooling-off period of at least seven (7) days after signing a consent form before booking surgery and paying a deposit. The cooling-off period for those under 18 years of age is three (3) months
- There will be a more detailed Informed consent document and process
- Accredited facilities will be required for cosmetic surgery
- New rules around the use of the title ‘surgeon’
- There will be more stringent guidelines around advertising by medical practitioners who perform cosmetic surgery