“Don’t waste time on tweakments, go for the scalpel instead – it’s actually better value for money,” a friend told me recently while recuperating from blepharoplasty (eyelid surgery to you and I).
Certainly the proliferation of botched filler is a stark reminder that there’s no such thing as a free lunch. It may appear the softer option, but injectables aren’t without complications. In the wrong hands they can create untold problems. Plastic surgeons tell me surgery is more complicated in the post-filler era, particularly when it comes to so-called biostimulators which can trigger the formation of ‘concrete-hard’ scarring that obstructs the nerves and distorts deep down tissues.
I know one well regarded oculoplastic surgeon who won’t operate on anyone who has had tear-trough filler and insists potential patients have an MRI scan at considerable cost before he’ll agree to operate.
There’s no denying that with a skillful practitioner dissolvable hyaluronic acid filler is a useful tool to restore volume in sunken areas such as temples and cheeks and, whether you agree or not, it’s the only real way to increase lip fullness which can be tremendously self-affirming for someone with next to nothing lips.
But since it can be injected by almost anyone, there’s a lot of questionable work about, especially when it’s being topped up more frequently than needed which can lead to everything from filler migration (the protruding duck lip) and lumpy under eyes to the standard case of pillow face whereby skin appears bizarrely inflated and contours merge into one another like melted wax. After all, if patients were told that some fillers can last up to 10 years as 3D scans now show, the businesses that rely on a steady rota of repeat appointments would take a considerable hit.
Compound the recent concerns surrounding non-surgical facelifts (Made in Chelsea star Melissa Tattam took to social media earlier this year to warn about a popular skin tightening energy treatment after incurring permanent post-inflammatory scarring), the gloss is coming off cosmetic treatments as a means to an end, driving home the adage that if something sounds too good to be true, it probably is.
The issue, says facial plastic surgeon Kshem Yapa, is that non-surgical procedures are being oversold. “You can’t fix facial laxity with filler or energy devices. Only surgery can do that,” says Yapa who concedes that, understandably, people want to avoid going under the knife, but turning to non-invasive methods to lift facial tissue can be a dead end.
Hollywood has known this for millenia. Rarely do they fess up, but actors and actresses are known to nip and tuck as early as their 40s. Dr David Jack, a prominent cosmetic doctor with clinics in London and Scotland called out the fact on Instagram recently, telling his followers: “Have you ever noticed how some celebrities have super straight jawlines?” he said, adding: “Please don’t despair, these people have had deep plane facelifts.” He concludes: “There’s nothing wrong with you if you have a bit of a jowl.”
It’s hard to reconcile that something as drastic as a facelift can go undetected, but facial surgery has advanced considerably in the last decade. Georgios Orfaniotis, a board certified plastic surgeon who specialises in the deep plane technique, says that, until recently, a facelift was deemed the last resort. The deep plane facelift is a more invasive yet natural looking method popularised by US surgeons such as Andrew Jacono, who performed Marc Jacobs facelift in 2021 when the fashion designer was 58. Jacobs, who admits to making the experience as theatrical as possible by posting his recovery journey on social media (he convalesced at New York’s iconic Carlyle Hotel), resurrected the facelift’s reputation overnight.
Jacobs may have made the deep plane high fashion, but social media took it to new heights, showing how subtly transformative it can be not just for well-heeled octogenarians but for women and men in midlife. “Social media has shown that surgery is the opposite of what we thought it was,” explains Orfaniotis referring to the wind tunnel effect associated with classic rudimentary techniques.
The pandemic changed everything, he declares, telling me that during the lockdowns when surgeons couldn’t operate they used the time to upload their work to social media – just as midlifers had extra cash at their disposal and time to contemplate self-improvements.
Just ask Tracy Hardy, 60, from Taunton in Somerset, who travelled to London to have a nip and tuck with Orfaniotis. “I’ve never used anything, not Botox, nothing at all. I wanted to have something that would last into my 70s, you know, give me a good 10 years,” she says, explaining that the decision to go under the knife was about confidence, not vanity. “I don’t think it’s even about looking youthful. It’s about looking refreshed; not so dragged down with the sagging, because my family trait is the sagging neck.”
“I’d gotten to the point where I stopped wearing makeup. I just didn’t I didn’t want to look in the mirror anymore. I didn’t recognise that person,” Hardy recalls. “I said to my husband, I’m doing it for me, to boost my confidence and, so I can look in the mirror again and not see these hanging folds of skin hanging underneath my neck. It really aged me.”
Hardy, who had a deep plane neck and lower face lift with Orfaniotis in January this year, is happy with her decision. “I’m extremely pleased with it. It looks so natural. In fact, I’ve had to tell people [I’ve had a facelift]. I’ve had to say: do I look any different?” she says, adding that despite a few tough days recovering from the six hour surgery, the recovery process was seamless, including the scars, which six months on are, says Hardy, are invisible. “You can’t see anything unless I lift my hair up and show you, you can’t tell I’ve had a facelift.”
Hardy is proud of her surgery, but for some, there’s still a stigma. “Having a facelift is so often shrouded in secrecy and it isn’t helpful – what we need is more transparency and to include surgery as part of a holistic plan to age well,” says Yapa.
Seemingly, change is a foot. A swathe of A-listers have gone public about going under the knife in midlife including Jane Fonda, Kris Jenner, Sharon Osbourne and the less obvious like singer Sia, 48, who presented Dr Ben Talei with a beauty award last year, telling the audience: ‘I’m a pop star that normally hides my face and doesn’t lie about s--t. I got an amazing facelift from Dr Talei. He is incredible.”
British reality TV star Caroline Stanbury, 48, and American presenter Catt Sadler, 49, have both publicly documented their facelift surgeries on various platforms, culminating in a joint discussion comparing their experiences on an episode of Sadler’s podcast, Catt Sadler Now.
It’s hard to know if normalising the facelift, as Sadler and Stanbury have tried to do, is moving the beauty standard even further out of reach – or whether celebrities opening up about something that, since the dawn of Hollywood, has been cloaked in secrecy, will help to soften the shame surrounding surgical intervention.
Contrary to narrow thinking, says Orfaniotis, a well-executed facelift isn’t about beauty. “It isn’t going to give you something you never had to begin with. When you perform a deep plane facelift, you’re simply putting the tissues back to where they used to be, restoring facial structure and refreshing the skin.” he reasons, adding that skilled facial surgery has become the great normaliser in a world of homogenous pillow faces.
For Hardy, the results have been life-changing. “I like looking around the shops again. I like buying new clothes, it’s given me a new lease of life,” she tells me.
Is it worth the £27,000 Hardy forked out? “If anything, I wish I’d done it sooner,” she says, concluding: “It was a lot of money, but you get what you pay for. You don’t want to mess around with your face.”
What is a deep plane facelift?
The deep plane facelift is an advanced technique that requires in depth knowledge of the facial anatomy compared to the superficial superficial musculoaponeurotic system (SMAS) facelift in which excess skin is removed and the remaining pulled taught.
The deep plane involves a deeper dissection of the tissues allowing the surgeon to pull the muscle, SMAS and skin upwards in one composite movement to de-tension the lift, thus avoiding the telltale signs of stretched skin. The benefits, argues Orfaniotis, far outweigh the SMAS as results are more natural and longer lasting, despite it being a more intricate and lengthy procedure with considerably more downtime. The deep plane is as appropriate for younger patients with subtle sag to more mature signs of ageing.
What scarring should you expect?
Typically a deep plane involves discreet incisions in front of the ear, sometimes behind the tragus (the cartilage in front of the ear) and along the hairline behind the ear. Incisions can heal as early as four months after surgery leaving inconspicuous scars (mostly disguised by the hair follicles) without much, if any, distortion of the ear anatomy.
Do endoscopic or scarless facelifts work?
Most deep plane surgeons will use traditional incisions that vary depending on the severity of the lift, but there are emerging techniques that harness minimally invasive methods with small to no scars – an obvious preference for Hollywood actors.
In the United States, surgeons such as Dr Chia Chi Kao in Santa Monica and Dr Marc Mani in Beverly Hills, offer scarless facelifts. However, they have their limitations. The first being the cost which is rumoured to be around $200,000. The second is availability. “There’s only two or three good surgeons in the world who do this technique,” he says. “It’s a deep plane facelift performed endoscopically, though it can take 16 hours to do well,” he clarifies.
What is the deep plane neck lift?
Another option is an isolated deep neck lift which involves an incision under the chin and one behind the ear. “However, it won’t address the lower face, therefore it’s mainly suitable for younger patients with genetically sloping neck tissue that can’t be addressed by non-surgical means.
Georgina Williams is a consultant plastic and reconstructive surgeon and the co-founder of the new Belgravia clinic, Montrose. She sees patients as young as their early 40s who are prime candidates for a deep neck lift. “Genetically some people have a very slack cervicomental [neck] angle. For them a neck lift can be transformative for their confidence,” says Williams who is gaining a keen female following in search of subtle surgical results.
Pain and recovery
Contrary to assumption, pain from a deep plane facelift is usually tolerable with most patients requiring paracetamol for only three days post surgery.
Healing can take up to six months. Surgeons recommend someone stay with you for two days following surgery and you’ll be offered pain medication and antibiotics should they be required. Bandages and a compression garment will stay in place for a week or so during which time you’ll need to sleep on your back. Most patients can return to work after three weeks and resume physical activities after two weeks but strenuous workouts should be avoided for six weeks.
You’ll have a follow up appointment after one week, after which you can wear makeup and wash your hair. Daily SPF is advised for the first month but active skincare should be avoided.
Bruising can take up to a month to settle down but can take longer if you’ve had a combination of neck, face and eye surgery, in which case swelling can take up to four months to completely subside. A good surgeon will assist with your recovery post-treatment from providing an aftercare team on call 24-7 within the first 48 hours to connecting you to holistic modalities like lymphatic drainage and scar massage to hyperbaric oxygen therapy to help accelerate recovery.
What age is the right age for a facelift?
The deep plane is suitable for patients as young as 40 but as Williams stresses, it’s not the age but your facial anatomy that should determine when or if the time is right. “Some people are candidates at 70, others in their 40s, it’s down to genetics and lifestyle,” she says.
However, Orfaniotis warns that results can be subtle the earlier the lift so patients need to manage expectations. “If someone comes to me in their late 30s for a facelift, I need to understand their history. If they’re someone who’s had a lot of cosmetic treatments from a young age and displays no anatomical signs of benefiting from a facelift, I won’t operate. If however, a patient has developed premature jowls or a loose neck and they have a realistic view of the outcome with a healthy attitude to ageing then I can really make a difference to their confidence,” affirms Orfaniotis. “There’s all kinds of circumstances that can lead to one person showing the signs of age more acutely than others, from illness to weight loss or genetics, which is why each case should be assessed individually.”
How long does it last?
The standard answer is 10 years but the truth is the longevity of a facelift depends on how good it is to begin with and how well your face ages over time. The first facelift is the most important. If it’s done right then you may be able to tweak here and there in the future without having to go back for major surgery. “The opposite isn’t always true,” says Orfaniotis , who believes that mini facelifts can be a false economy. Naturally, no one needs a facelift or to repeat a facelift.
Finding a good surgeon
Credentials count. If you’re having facial surgery in the UK your surgeon should be a member of BAAPS (British Association of Aesthetic Plastic Surgeons) to ensure they have the highest level of training and qualifications. Ideally they would also be on the General Medical Council (GMC)’s specialist register. This ensures they’ve completed a fellowship in the specialist area they practise and are eligible to work as a consultant plastic surgeon in the NHS.
In more practical terms, word of mouth is the most compelling indicator. If you’re seriously considering a face lift, set aside £1,000 for consultations which cost around £300 each. Ask to see the surgeon’s past 10 to 15 cases with before and after photos as whoever does your surgery should have recent case studies to reference. Facelift techniques and practices continually evolve with advancements and experience so you’re looking for someone who is operating on a regular basis.
How much does it cost?
Prices for a deep plane by a reputable surgeon in the UK start at around £17,000, though experienced surgeons will charge close to double that for the face and neck. Costs will increase by around £5,000 for fat grafting and more still if you combine eye surgery.
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