Amanda Preisinger is anxious about her daughter’s impending 13th birthday party. Not for the usual reasons related to a house full of clamorous preteen children, but because it’s the first time that she will debut her new face to friends and extended family. “Obviously I’m going to tell everyone as they come in, ‘Just so you know, this is not how I look,’” says the 30-year-old real estate agent from south Florida.

How she looks is, well, a little startling – her face swollen and preternaturally lifted, as though held together by industrial-grade tape. Her new – and she’s keen to stress, temporary – look is the result of six cosmetic procedures, including an endoscopic mid-facelift, performed by a doctor in Istanbul, Turkey, last month. “My poor husband teared up when he saw me for the first time because I couldn’t even open my eyes. That’s how swollen I was,” she tells me via video call from her house. “I had to tell him: ‘Babe, I’m fine, I’m not hurting. I just look like someone jumped me.’”

According to plastic surgeons, Preisinger is one of a growing number of people electing to undergo a facelift in their 20s and 30s – well over a decade before most doctors’ typical patient age range of 40 to 60. (Though most surgeons are keen to emphasise the industry edict of: “We treat genetics, not age.”) “I have 28-year-olds asking for facelifts,” says London-based aesthetic plastic surgeon Georgios Orfaniotis, a former NHS consultant who specialises in the head and neck. “It’s a very significant procedure, and I’m a bit concerned when I see people choosing it as a lifestyle choice.”

A facelift, also known as a rhytidectomy, lifts the ligaments in the face that begin to droop as we age. “Our faces are built a little like layers of an onion,” says Kent-based facial plastic surgeon Marc Pacifico. “Skin and fat on the surface, then a layer of connective tissue called the SMAS – the superficial musculoaponeurotic system. Think of the SMAS as the soft tissue skeleton of the face. And that’s what ages us; that’s what loosens and sags and drags the skin down with it.”

Once the preserve of moneyed older people, “filler fatigue” – when overuse of dermal fillers stretches the face and causes laxity in the skin – alongside the widespread use of weight-loss drugs, cut-price medical tourism, and the development of new, celebrity-endorsed surgical techniques are driving a new kind of customer towards this invasive surgery. The British Association of Aesthetic Plastic Surgeons (BAAPS) has reported an 8 percent increase in facelifts over the past 12 months in the UK; while a survey by the American Academy of Facial Plastic and Reconstructive Surgery found that the portion of younger facelift patients is growing, with 32 percent of facelifts now performed on patients aged 35-55.

“People are asking now to look like the best version of themselves and obviously the techniques are following,” says Orfaniotis. Currently, the operation du jour is the deep plane facelift, a technique evangelised by everyone from Kardashian matriarch Kris Jenner, to fashion designer Marc Jacobs.

Where a more traditional facelift involves lifting the SMAS, the deep plane facelift releases the facial ligaments beneath it, allowing surgeons to reshape the face by moving the deeper tissue, and avoiding the taut, pulled look sometimes wrought by more traditional techniques. “We’re not putting tension on the skin because we’re going below, to the deeper tissue,” says Harley Street plastic surgeon Rajiv Grover, who specialises in the deep plane technique. “It is the deeper tissue that is repositioned. The skin comes with it as a passenger.” Lifting the entire soft tissue layer as a single unit allows for a more natural-looking and longer-lasting result. It also means that the procedure is no longer being used for the express purpose of anti-ageing – or rejuvenation, as the aesthetics industry terms it – but for “beautification” and facial restructuring, too. “We’re getting many inquiries from patients aged 28 to 35 for this reason,” says Grover.

Preisinger had never planned on getting a facelift – at least not at the age of 30. But years of using hyaluronic acid dermal fillers in an attempt at “facial balancing” meant that by the time she reached her late 20s, she was “botched”. “I didn’t do this because I wanted to look young,” she says. “I did it because the filler ruined my face. I wish I had never done it. If I didn’t have the filler, I don’t think I would be where I’m at right now.”

Whether dermal fillers ever fully dissolve has long been a point of contention in the aesthetics industry. “Studies have shown that not only do they rarely completely dissolve,” says Grover, “but they migrate and can block lymphatic channels. One of the contributors to what we call ‘pillow face’ is also the fact that in a sense, the face becomes slightly waterlogged because its ability to drain lymphatic fluid has been diminished.” Though research into the area is preliminary, BAAPS issued a cautionary statement on dermal fillers’ potential impact on the lymphatic system at its 2023 scientific conference, and announced further research into the area. One highly regarded facial plastic surgeon, speaking to me on the condition of anonymity, says he would never use fillers in a patient because of the risks they pose. “A lot of surgeons don’t want to talk about this, because the companies who manufacture filler can be pretty aggressive.” He’s heard stories, he says, of plastic surgeons in the US being landed with court orders after raising their concerns.

For Preisinger, once she started injecting filler, she felt as if she had to keep replenishing it – especially as it started to migrate to other parts of her face. She was just 28 when a local plastic surgeon in Florida suggested that a face and neck lift might be what she needed to finally step off the injectable hamster wheel. Two years later, she found herself choosing between a list of recommended hotels in Istanbul, texted to her by the patient coordinator at her surgeon’s office.

Originally, Preisinger had planned for an upper and lower blepharoplasty – better known as eyelid surgery – but her surgeon advised her that a facelift was the right solution for the laxity she was finding in her face. She booked a forehead lift, a mid-facelift and a neck lift. The day before her surgery, one day after she’d touched down alone in Turkey, she decided to add a lip lift. “Then he [the surgeon] said, ‘We’re going to lift the under-eye bags.’ Then he said, ‘I think if we remove some buccal fat, it will contour your face.’ So I ended up adding two more procedures,” she says. She paid $22,000 (£16,500) for the six-hour operation, plus a three-day stay in a luxury medical suite that looked less like a hospital than a nondescript posh hotel. (Her actual hotel, where she would spend four further days recuperating with ice packs and an all-liquid diet, came at an additional cost.)

Facelifts in the UK can cost anywhere from a few thousand pounds to high double figures, depending on the surgeon. “It’s so strange: the more you have, the cheaper it is,” says 40-year-old Lucy Argent, who had a deep plane necklift two years ago. Argent, who is from Cambridge but now lives with her family in Bali, had always been bothered by her neck and chin, so when she was quoted £5,000 from a UK clinic to have a partial deep plane neck lift (essentially, the contouring of the tissue without the skin lift), she jumped at the chance. “I’d never had cosmetic surgery before,” she says. “It’s almost like being a kid in a candy store. You’re obviously talking about major operations, but if you go in for a consultation, they’re like, ‘Oh if you want to add in a brow lift or a breast lift, you can. You can have your arms liposuctioned too.’ I did walk away from that thinking, at least I was of sound mind. And they do finance, so it’s not like money’s a problem. It did give me a bit of an icky feeling.” Argent, whose third child was then just a year old, ended up adding a breast lift to her package, bringing her total to around £9,000.

“I was shocked by how accessible it was,” she says. “I was still coming out of that baby weight stage. As much as everyone at the clinic was lovely, I do think that the plastic surgery industry takes advantage of women who are postnatal, unhappy with their bodies and losing their identity. I could have had everything done and nobody would have stood in my way. At no point did anyone say to me, ‘Maybe you should spend a year doing this exercise, or trying this diet.’ I’m in a much different mental state now than I was two years ago.”

All of the surgeons I spoke to for this piece said that though it depended on each individual case, they were unlikely to operate on patients in their 20s and 30s for purely cosmetic reasons. “You can take a 28-year-old and make their jawline better,” says Orfaniotis. “You can make them look like the best version of themselves. But where is this going to end? When you’re looking at beautification on people in their 20s or early 30s that otherwise look absolutely fine, you risk operating on people that have deeper issues. It’s not a practice for an ethical plastic surgeon to follow.” And yet when I put in a few cursory inquiries with surgeons in Turkey, none of them flag that at 28, I might be too young for a deep plane facelift. I try – and fail – not to take it personally.

Amy Endean, a 34-year-old supported living facility manager from Worcestershire, was initially refused a facelift by her plastic surgeon when she inquired four years ago. It only confirmed what she had already suspected following meticulous research: that this was the right surgeon for her.

When Endean was 16, she was a backseat passenger in a car that hit a wall when the driver took a corner at speed. She shattered the left side of her face, and had to undergo full reconstructive surgery. “They pulled my whole face off from the chin up,” she says. Surgeons replaced and rebuilt part of her jaw and nose, and placed titanium plates in the parts of her skull that had fractured and cracked. Throughout the following decade, she had major surgeries “pretty much every year”.

By the time she was 25, she knew she’d have to have major plastic surgery owing to all the movement in her face. She began to develop an obstructive double chin that made it difficult to breathe or swallow when she lay down – the result of her facial fat dropping to her chin after surgery. She was 30, but the structure of her face was more akin to that of someone in her 60s. After consulting with both Endean and her family, her surgeon finally agreed to do a deep plane facelift, a brow lift and a chin implant. “It didn’t make me look snatched and pulled – it just made me look how I’m supposed to look for my age,” she says four years on. She’ll likely need further, smaller tweaks in the years to come – last year a swollen lump under her eye turned out to be a piece of metal from the car that was still embedded in her face – but her facelift has meant that she won’t have to undergo annual surgeries. Since the procedure, she has married and had two children, which she says wouldn’t have been possible had she been repeatedly in and out of hospital.

When private cosmetic plastic surgeons espouse the virtues of their “life-changing” work on social media – invariably accompanied by a before and after of a tech CEO or an influencer – it’s hard not to reflexively scoff. But for people like Endean, the advances in the procedure really have been life-changing. “I don’t know what I’d have looked like if the accident never happened,” she says. “But now I feel like I still look like me.”

As for Preisinger, she’s following a strict post-op routine of ice-rolling and facial massaging, in the hope that the swelling will soon begin to settle. In six to eight months she’ll be back in Istanbul for a check-in with her surgeon – a flying visit on the way to Italy for a family holiday. “I’m so excited,” she says. “I know that my results are going to be amazing.”

By Kate McCusker

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