Is 45 Years Old Too Young (or Old) for a Face-lift?

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Q: I really enjoy all your articles! I have been talking to lots of women about the dreaded face-lift. When is the best time? Are they always necessary? What is the best age for the best outcome? I decided to have consultations with three top New York City plastic surgeons and they all agreed, the younger the better. The current trend seems to be 45! I’m 55 and I am stunned. What are your thoughts? 

A: I have so many thoughts about this! Is this one more example of the youthification of anti-aging marketing, like promoting “Baby Botox” for women in their 20s and 30s or selling skin care to preteens? Like you, dear Reader, I’m having a hard time wrapping my head around the concept of a face-lift at 45. Especially now, at 73, when most 45- or 50-year-olds look like adolescents to me, it seems not only unnecessary but unhealthy to submit to surgery.

One argument for early surgery is the “one and done” idea: Go for the big guns rather than an accumulation of tweaks so that you can just forget about it (the “it” being maintaining a youthful face). And some plastic surgeons are claiming that a face-lift is more challenging on a person who has had neurotoxin and filler, so if you take the tweakment route and then decide on a face-lift, it’s going to be more complicated.

I asked plastic surgeon Alan Matarasso, M.D., to explain the thinking behind the 45- to 50-year-old recommendation. “We say that 45–50 is the sweet spot for a face-lift because that’s when we first start to see the signs of aging, like jowling and sagging — but the skin hasn’t yet lost a lot of collagen and elastin,” he said. “So the results of a face-lift are more natural.” Natural? “Less dramatic, more subtle than what you see in a person who waits till 70,” whose skin is damaged by intrinsic or extrinsic factors like sunlight or pollution. But! Not every 45- or 50-year-old would benefit from a face-lift, because if they’ve been taking care of their skin, it isn’t indicated — they don’t need it, he said.

So it seems the reason your three surgeons suggested the 45–50 age range is simply because from a physiological standpoint, the surgery has better outcomes. From this perspective, surgeons are like mechanics: They get better results with undamaged materials, so of course they recommend that you see them before you’re “damaged.” But that doesn’t take into account other critical factors, like the skin quality of an individual patient or their individual needs.

Basically, if your skin is healthy, a face-lift at that age seems essentially a preventative measure to slow down the aging process rather than to ameliorate the cumulative manifestations of age. Who doesn’t want to slow down the aging process? (Anyone who says they don’t hasn’t thought enough about death.) But there are now an abundance of ways to slow it down without submitting to a scalpel, the obvious being exercise and diet, along with the vast array of playthings — lasers, heat-based devices, neurotoxins, fillers — in the dermatologists’ or plastic surgeons’ offices.

But a face-lift is not like a 401(k), where the earlier the action, the higher the yield. If that were the case, why not have a face-lift at 30? Or 25? As Yasmin Tayag wrote in The Atlantic, “It used to be enough to have a youthful appearance, but the norm is moving toward looking like you have not aged at all.” Tayag is on to something; the idea is reinforced by the current spate of entertainment about the punishing results of middle-age women with ambitions in that regard (The Substance and soon on Broadway, Death Becomes Her, for example).

Matarasso turns away patients who come to him for procedures he believes are unnecessary. And he says age isn’t a contraindication for a face-lift (“Not long ago, I did an 85-year-old on her fifth husband and her third face-lift”). Which means that if you choose to climb onto the face-lift bandwagon, there is no rush; as long as you’re in good health, there’s no reason to think the opportunity has passed you by.

But I have to tell you that the older I get, the less interested I am in an elective surgical intervention (not that I ever was, especially). For one thing, I’ve learned to love my face the way I love the faces of dear friends and family and to not constantly scan for flaws; for another, the ageism in our culture is supported by our refusal to accept (and respect) the value of elders, and a face-lift for me would be a fierce validation of that refusal; and finally, I believe what makes older people attractive isn’t their face, but instead engagement, curiosity, and kindness. Which isn’t to say I’m against a face-lift if that’s your choice. I’ll fight to the death for your right to choose it, but I’ll never defend a culture that nourishes your belief that you need one.