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About Face

Chapter Six The Face-lift Lower Face-lift Liposuction The Chin

C H A P T E R S I X

The Face-lift

OF ALL THE THINGS that a cosmetic facial surgeon can do for people, the face-lift is surely the most talked-about. Perhaps it’s because some entertainers have so long been associated with this particular operation. Singers and dancers and actors, by virtue of the business they are in, often are insecure about aging and obsessed with their appearance. Maybe it’s this connection that makes the face-lift so controversial. But not everyone who decides to get a face-lift is driven by such extreme forces.

In a certain sense, a face-lift is one of the more innocuous procedures that a patient can choose. People who turn to plastic surgery for a hair transplant, or perhaps a new nose, are looking for a dramatic improvement in their appearance; a change. This is different from what most people want from a face-lift. When these people look in the mirror, their aging appearance does not match up with their psychological impression of themselves. This impression is sometimes referred to as the “body image”. they want the image in the mirror to reflect their psychological self-portrait.

Sometimes people seek out a face-lift as a reaction to the death of or separation from a spouse; it’s an attempt to put things back the way they were before a tragedy. These patients need grief counseling before they consider a face-lift. As I explained in the introductory chapter, cosmetic surgeons devote a lot of time to screening potential candidate for surgery, and this is one area in which we are particularly cautious. A mid-life crisis must be separated from simple dis-satisfaction with a middle-aged appearance.

The earlier a patient has a face-lift, the more frequently the procedure will have to be repeated to maintain the desired effect. A “middle-aged” patient of forty-three may want to restore a look with hardly any sag at all, to recapture a thirtyish appearance. This would mean the procedure would have to be repeated five years later. But if patients wait until they are about fifty-five, when they have come to accept a bit of natural sag and wrinkling, it will likely be a one-time operation. A rough estimate is that if you get a face-lift at forty, it will last five years; at fifty, it will last seven to ten years; at fifty-five, it will last a lifetime. Cosmetic surgeons have a jaunty little expression that sums it up: “Recurrence begins as the last stitch goes in.”

As I mentioned earlier, everyone ages at an individual rate, but there are some generally applicable periods when aging is gradual or accelerated. Most people age gradually to about age fifty. The aging process accelerates between fifty and sixty, then “plateaus” between sixty and seventy. After seventy, the process speeds up again. A patient’s rate of aging might have a bearing on the best time to have a face-lift.

Studies have been published that examine the connection between a patient’s psychological health and the desire for a face-lift. In 1935, The Journal of Applied Psychology published a piece by psychologist C. Buhler as to what constitutes a healthy, well-adjusted, middle-aged person; this piece has become something of a benchmark against which to measure the motivations of candidates for a face-lift.

According to Buhler, valuable assets in coping with middle age include a flexible attitude toward others, a variety of interests, a healthy self-regard, a willingness to accept help from others and a realistic assessment of one’s own abilities. In my experience, most face-lift patients may be slightly deficient in one or more of these areas.

The results of many cosmetic surgery operations help to build self-esteem, though few are as effective as the face-lift. Four out of five face-lift patients treated in my office are women, but I’ll use the example of a widower to illustrate my point. When he first came to see me, this middle-ages gentleman had lost his wife a year earlier. He was having a lot of trouble reaching out to make friends and socialize. We agreed on a face-lift, and he has since begun to date and enjoy life again. The truth is, the face-lift changed his self-esteem more than it changed his appearance. His confidence got a big boost.

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