Is 40 Too Young For A Facelift?

Many things in life have an age restriction: drinking alcohol, getting your driver’s licenses, and gambling, to name a few. One thing that has never had a definitive age requirement yet has always been associated with a more mature demographic: the facelift. Historically, the facial rejuvenation procedure counts women and men experiencing more advanced signs of aging as its typical patient. However, an increasing number of younger folks are interested in and getting facelifts in their early forties.

This begs the question: Can you be too young for a facelift? We asked the experts.

The Shift Toward Younger Facelift Patients

“People of all ages always want to look their best, but women in their forties are now feeling in top form, and they want their appearances to reflect that,” says Andrew Frankel, MD, a double board certified facial plastic and reconstructive surgeon in Beverly Hills. And then there is the influence of social media. “Additionally, social media puts a premium on beauty, and this creates an added pressure for people who would otherwise not be that concerned with some early signs of aging,” he notes.

As conversations around plastic surgery have normalized (hi, Marc Jacobs), we now have more access than ever to before and after photos and procedure information. That mainstreaming has made patients more familiar with what’s possible from both a rejuvenation and prejuvenation perspective. “Women are more aware of what is available to them to achieve their desired look,” says Stafford Broumand, MD, a board certified plastic and reconstructive surgeon at 740 Park Plastic Surgery in New York City.

For many, the early forties is when the first signs of visible facial aging start to appear around the jawline, chin, and neck. “Women start to notice a loosening and hanging of the skin, as well as jowls, and sometimes crinkly, wrinkly, sun-damaged skin,” explains Robert Guida, MD, a double board certified facial plastic and reconstructive surgeon in NYC. “These signs of aging become more noticeable in thinner women or those who have recently lost weight from dieting.” Unsurprisingly, COVID-19 has also influenced procedure preferences. “Since the pandemic, women are noticing these facial changes more thanks to Zoom calls and social media photos, which has led to an increase in those in their early forties getting facelifts,” she says.

Just because you hit the biological age of 40 doesn't necessarily mean you are guaranteed to see age-related changes that necessitate surgical intervention. We all age at different rates, and 40 does not look the same from one person to the next. “Some women have minimal signs of aging and others appear to look much older than they are with sun-damaged, inelastic skin and laxity,” Dr. Frankel says.

So, your biological age should not be why you have a facelift. Instead, let the degree of looseness in the skin and neck be your guide. “A facelift is not for everyone,” advises Dr. Broumand. “But when patients have early jowling, a facelift, concentrating on the neck and jawline, is the gold standard.”

Filler Fatigue

Minimally invasive procedures all have their place in the modern anti-aging routine. But, be that as it may, some patients feel they have taken those procedures as far as possible and the next step is required. When injectables (think: neurotoxin and filler) and non-surgical skin-tightening treatments don’t cut it anymore, the best remaining option is often a facelift. “Patients get facelifts because they work better than Botox® or injectables for loose sagging skin of the neck, jowls, and face,” Dr. Guida says. “Often, I suggest patients start with Botox®, fillers, neck liposuction, or skin resurfacing if they are hesitant about having an operation.”

Furthermore, the over-injected, puffed-up, unnatural face is no longer in vogue. “Too many providers overfill their patients, which leads to filler fatigue through premature aging of the tissue by overextending the skin,” shares Julius Few, MD, a board certified plastic and reconstructive surgeon in Chicago and founder of the Few Institute. “In addition, this undesirable appearance will often lead a woman in her forties to say, ‘Enough! I want a facelift and no more filler.’”

Research supports the newfound reality. A 2017 study in the Aesthetic Surgery Journal reveals the average age of a facelift patient is declining. More than 50 percent of women who have a mini-facelift in their forties had previously had injectables, fillers, or lasers. The patients indicate that they looked four years younger after these non-invasive treatments but almost 10 years younger after their facelift.

The 40-Year-Old’s Facelift vs. the 65-Year-Old’s Facelift

The fundamentals of a facelift on a younger patient and an older patient are the same, yet the execution is different. “There’s just less manipulation needed in younger patients,” Dr. Few notes. “This may seem easier in principle, but it is the opposite.” As he explains, younger patients can quickly look “overdone” and “over-pulled” if not treated carefully. “Younger patients focus on the lower face and early neck aging,” he says. They also tend to be very adamant that they don’t want to look ‘done’ or fake.

Even so, Dr. Guida says the quality of younger skin can make surgeons’ lives a bit easier in the OR. “Good facelift results are easier to achieve in a younger patient because the skin still has good elasticity and tone due to less sun damage and less aging,” he explains. “And the dermis of the skin and the underlying muscle, which I tighten in a face and neck lift, are stronger in younger women and technically easier to achieve a better result.”

Any skilled plastic surgeon knows the importance of personalizing facial surgery. “I always customize the face-neck lift procedure to the patients’ needs,” Dr. Guida notes. Based on science and genetic principles, no two faces are exactly alike, which is why no two facelifts are the same.

The Modern-Day Mini-Facelift

Today’s facelifts are not like the ones of yesteryear. Gone are the over-pulled, super tight, wind tunnel-look that appears fake, narrow, and waxy. In its place are more comprehensive yet minor surgeries that garner a refreshed, ‘still-you-but-better’ look. “The techniques that we surgeons have developed over the last decade have made the results much more predictable, durable, and even faster to recover from,” Dr. Few says.

A modified, limited version of a traditional facelift, the so-called mini-facelift zeros in on excess skin on the neck and jaw. Younger patients almost always have less skin laxity (unless there is extreme weight loss) than older patients. In addition, the tissue in the cheek area has not lost as much volume or support, and these areas do not typically require correction.

Facelifts in 40 year olds usually have a limited incision and not as drastic a pull. The incisions, which are smaller than traditional facelifts because less tissue and muscle manipulation is necessary, are made in front of and behind the ears. Dr. Frankel explains that when there is less laxity, it is even more important to release the tissues (dissect more) so that there is not too much tension on the incisions. This allows for better healing. “Additionally, most women in their forties don’t need as much skin removed, so the dissection often stays deeper,” he adds. With time, the ensuing scars will fade, so patients can still wear their hair up.

Some surgeons, like Dr. Few, choose to incorporate other age-rejuvenating treatments into the overall revitalization plan. “Filler, especially in the lower face and neck, should be considered as an addition — not a primary tool — for lower face drooping,” he says. “I prefer to do suture suspensions in this age group, as our research has shown near-surgical results without the need for cutting. The inverso suspension concept incorporates relaxing the frown muscles of the lower face, combined with minimal volume filler and thread lifting to the lower face and jawline.”

Dr. Frankel is of a similar mindset and also uses injectables and neurotoxins in conjunction with facial rejuvenation. “Longstanding maintenance involves both approaches,” he says. “Surgery is much more dramatic than non-surgical alternatives, and, usually, the results are visible within a shorter time.” At the end of the day, it all works together synergistically. “An ‘early’ facelift lasts around 12 years, but little ‘tweaks’ with filler and such are often done along the way to optimize things,” Dr. Frankel shares.

Weight maintenance and skincare also hold a lot of clout in achieving and maintaining good results. “A solid, simple skincare regimen from an early age sets skin up to age well,” Dr. Few explains. “We created our skincare line, Aforé, with this in mind to restore and maintain your skin in a state of 'before' — before the sun damage, exposure to pollution, and signs of aging.”

Is Younger Better?

If a facelift sits at the top of the priority list titled ‘Things to Do in My Forties,’ there can be a benefit to going under the knife while still a quadragenarian (as long as your plastic surgeon deems you a good candidate). Having surgery early on, while age-related concerns are still relatively minor, eliminates the need for a more complete restoration down the line. Medical and surgical advances also mean a quicker recovery. “Patients are not down for months at a time anymore,” Dr. Broumand says. “Instead, they are back in the office seven to 14 days later.”

And let’s not forget about the cost factor. Younger patients who have ‘mini’ lifts may incur a smaller price tag because there is less work and time involved on the surgeon’s part. “Plus, some patients opt for a lift because other modalities are not giving an extreme enough result anymore or they have become too expensive to maintain,” Dr. Broumand adds.

The results will last for years no matter your age. It’s important to remember that the face will continue to age, just from a different starting point. “The bones continue to change size and shape, the skin thins and loses elasticity, and facial fat diminishes over time,” Dr. Frankel notes. Most patients start to notice some relaxing of the skin and tissues around the 10-year post-op mark. “The face will still look better than it did before the surgery, and it will not go back to its original appearance,” Dr. Guida says.

The Takeaway

Non-surgical solutions certainly have their place, and, for some facelift patients, they continue to be part of the anti-aging plan — especially for upkeep. After all, just because you opt for facial surgery at an earlier age does not mean that you will become immune to aging — you won’t. “A facelift will not stop the clock, but it will reverse it,” says Dr. Broumand. It’s also important to recognize that additional surgeries may be needed in the future to maintain results. “Once a patient has a facelift early, they are very likely to feel the desire to do a second one — this is the warning I give any patient considering a facelift in their early forties,” cautions Dr. Few. But, until then, you’ll look fabulous!

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