Does Anyone Still Get a Face-Lift?
There’s a particularly memorable scene in Terry Gilliam’s 1985 dystopian cult classic Brazil in which actress Katherine Helmond’s face is being pulled and prodded by a man in quasi-medical garb. “Just try to relax, and I’ll make you 20 years younger,” he says, laughing as he dramatically pins her skin back with binder clips and wraps it all taut with cellophane.
It’s a bizarre exaggeration, but it nails exactly what has long been the primary fear of anyone pondering a face-lift. “Everyone’s afraid of looking tight,” says New York plastic surgeon (and author of The Park Avenue Face) Andrew Jacono, alluding to that telltale stretched effect we all dread.
The traditional approach to face-lifting—one still employed by the vast majority of surgeons—involves separating the skin on the lower jaw from the muscle layer and hoisting it upward, thereby addressing the laxity of the jaw, jowls, and neckline that comes with age for most of us. “It makes your jawline tighter, but it can sometimes look like a beach ball on a popsicle stick,” Jacono says. It also can require the use of filler or fat grafting to fill out the cheeks, and it comes with the potential for noticeable scars and lengthy recovery periods.
Now there’s a wave of plastic surgeons cultivating a new, and decidedly more -subtle, approach to the face-lift, fine-tuning techniques that are minimally invasive and require significantly less downtime (a week versus a month). One is Jacono’s MADE (minimal access deep--plane extended) procedure, which he calls a deep structural repair of the face, albeit one that remains “-ponytail-friendly” (his incisions are a third the traditional length and are tucked far behind the ear).
Jacono keeps the skin, muscle, and fat together as a unit, and zeros in on the facial ligaments. “It’s like an ACL repair,” he says. “I release the ligament that gets stretched out, and the deep fat pads and muscles get repositioned vertically, so that makes the face look youthful and heart-shaped again.”
Dr. Matthew White’s signature Golden Angle Lift is similarly based on the nuances of facial ligaments. “We’re focusing more on the deeper connective tissue blanket, which is like a bed sheet: If it’s crumpled, the duvet won’t lie smoothly on top of it,” he says. “When we go in and just repair those ligaments, it’s much more natural-looking.”
As surgery has evolved, so too has people’s relationship to procedures in general. “Fillers and Botox have really redefined the nature of surgery,” says Chicago-based plastic surgeon Julius Few. He believes that when used very judiciously over time, injectables can support needed volume while also minimizing the excess movement that can wear at tissue, thereby putting off the need for surgery.
Jacono, though, thinks that for substantial aging concerns, fillers have an expiration date. “When women start doing fillers in their late thirties and early forties, it accelerates the aging process,” he claims. “Fillers expand the facial tissue, so as you continue to use them you have to add more, because the face gets looser, but that actually weighs the face down, making it look wider.”
Carolyn Chang, a plastic surgeon whose San Francisco practice serves a large Silicon Valley clientele, considers injectables an excellent way to give people an idea of what their skin could look like with a temporary anti-aging assist. “But at the end of the day, surgery is always going to win,” she says.
Not only are people still going under the knife, they’re doing it younger than ever before. “The average age for a face-lift in my practice right now is 47,” Jacono says. The rise of social media may have helped provoke the shift by casting a new and omnipresent spotlight on appearance. But there has also been a gain in life expectancy, with people living and working longer and wanting to maintain their youthful look.
“People in their sixties now look the way those in their forties did 10 years ago,” White says. And there may be a benefit to starting earlier. “You don’t gain anything by saving up aging,” Chang says. “When you get a good face-lift when your skin is still better, you get a more complete correction that lasts longer. You cheat nature that way.”
It’s a trick that more men are signing up for as well; Jacono reports seeing a jump in male face-lifts from 2 percent of his procedures to 20 percent. “Men are even more motivated by workplace pressure than women,” says Chang, who tends to a lot of male CEOs who find themselves surrounded by a much younger workforce. Men tend to bruise less than women, because their skin is thicker, she adds, which means they often heal faster, too.
While injectables can lend themselves to overuse, a phenomenon sometimes referred to as “Instagram face,” the most dramatic aspect of the 2020 face-lift may be that it’s not that dramatic. “The biggest change is that the modern face-lift doesn’t look like a face-lift,” Chang says. The best work has always gone unnoticed—and now that’s easier than ever to achieve.
Ready to Commit? Here's Who to Call.
New York: Dr. Andrew Jacono, Dr. Matthew White, Dr. Melissa Doft Chicago: Dr. Julius Few, Dr. Chin Chi Kao Los Angeles: Dr. Carolyn Chang
This story appears in the May 2020 issue of Town & Country. Subscribe now
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