Preventative Facelifts Are Replacing Filler & Botox

For years, Botox and filler have been entry-level treatments into the world of aesthetics and, eventually, more invasive plastic surgery procedures. A few annual injections to plump up the face and smooth out lines and wrinkles are often coupled with lasers to zap away mild skin laxity, and even thread lifts to "pick up" the face made the idea of needing a facelift far ahead of 60 nearly obsolete. In fact, for years, experts thought that with the advent and fast-track of non-invasive options, facelifts would only be reserved for when necessary and possibly fall to the wayside.

But all of that is changing, and rather than becoming a surgical procedure reserved for older patients, the facelift is, yet again, having a major resurgence. This time around, younger demographics are looking to the surgery to proactively tackle the first signs of aging and preemptively change how their face is destined to age — well, to some degree. Known as a preventative facelift (it sometimes goes by the name of a mini lift), it's becoming popular amongst those in their 30s and 40s, changing the idea of a facelift as a corrective procedure to a proactive one to offset aging in a whole new way. In its 2023 member survey outcomes, the American Academy of Facial Plastic & Reconstructive Surgery found that on average, members performed 48 facelifts or partial facelifts in 2023, a 60% increase since 2017. The survey also noted an increase in patients aged 35 to 55.

Ahead, TZR dives into the trend of preventative facelifts, how they work, and who they are for so you can determine if it's time to back off of filler and opt for something more permanent.

The Rise Of Preventative Facelifts

According to Dr. Melissa Doft, M.D., a double board-certified plastic surgeon in New York City, a preventative facelift is performed at an earlier age than someone would typically have the surgery. "Historically, patients waited until their 50s or 60s to get a facelift." Today, more and more younger patients undergo facelifts to correct an obtuse neck or mild jowling. “Performing surgery on younger patients also gives way to longer-lasting results because their skin quality is superior," she adds.

However, talks surrounding preventative facelifts tend to have those interested in the procedure thinking it is a specific treatment done at a particular point to address certain age-related issues. In reality, Dr. Miguel Mascaró, M.D., a board-certified facial plastic surgeon in Delray Beach, FL, says it's slightly more nebulous than that. "Many people are slowly realizing that non-invasive procedures such as radio frequency treatments, ultrasound-based energy modalities, injectables, and biostimulators can only do so much, and they can only get you so far. At some point, significant volume loss and excessive skin laxity becomes more of a surgical fix,” he explains.

While non-invasive treatments have been an easy way to intervene with the effects of aging to some degree, they do not offer the same result as surgery. Patients have been investing thousands upon thousands of dollars in non-invasive treatments and overfilling their faces for years. Many are now dissolving their fillers and turning to a facelift instead. "Focusing on anti-aging procedures to maximize [the appearance of] youth has become paramount in today's culture. More and more younger patients are coming in to have a minimal facelift procedure, looking for increased longevity due to improved skin and a definitive result,” Doft says. “They also want a natural-looking jawline, which cannot be achieved with aggressive filler placement.”

As the plastic surgery pendulum swings from once waiting for the effects of aging to become full-blown before getting work done to making small tweaks at a younger age, the idea of an early intervention approach is what Mascaró says equates to all of the stigmas that have surrounded facelifts for so long, like looking drastically different, significant downtime and recovery, and the idea of undergoing a huge procedure, are also being thrown out the window.

What Happens During A Preventative Facelift

During a preventative facelift, Doft explains that the SMAS layer of the face (tissue that extends from the neck up toward the forehead) is tightened, and excess skin is removed. "This can be achieved through many techniques such as SMAS plication, SMAS flap elevation, and a deep plane facelift. Some preventative facelifts involve an incision under the chin if there are concerns of aging in the neck." Complimentary procedures can address concerns regarding the eyes and brows.

Another point of distinction between a standard facelift and a preventative one is that with the latter, there's less work done on the central part of the neck. With a complete facelift, Mascaró says it involves exploring the area between the platysma fibers and tightening that and the glands and central compartment. "With a preservation facelift, there's less work on the neck because most young people don't have big, hanging necks. Simply pulling the skin tight gives them a nice contour."

Mascaró adds that this facelift requires less skin lifting off the muscles. "We lift a little bit of skin, gaining access into the deep plane or that plane where all the muscle area is and release some of the key ligaments that need to be positioned. Since there's not as much skin elevation during this facelift, there isn't as much of a release of the deep tissues but more of the ligaments and repositioning, giving way to a faster recovery."

However, Dr. Jennifer Levine, M.D., a double-board certified facial plastic surgeon in New York City, is quick to point out that despite the rise of early facelifts, no type of cosmetic surgery is entirely preventative for treating signs of aging on the jawline and neck. "These early facelifts can prevent ‘pillow face’ or trying to achieve a surgical-like result with excessive filler,” she says. "Surgery will give the best result rather than more subtle improvements that do not lead to full correction.”

Who Should Get A Preventative Facelift?

The ideal preventative facelift candidate notices changes to their face, especially in the lower third of the face, with increased jowling and loose skin. Those most interested in getting the surgery early on are usually focused on “the goal of raising the cheeks, smoothing the jawline and better defining the neck,” Doft says. Yet, there must be enough skin laxity with a loss of elasticity to pick up the skin properly. “If there’s not enough flaccidity, the surgery may not be worthy of a scar just yet,” Mascaró adds. An easy way to assess if a preventative facelift is right for you is by placing your fingers at the cheekbone and mandible. “As you gently move them up and back, if the corners of the mouth pull backward, that means there is enough laxity and lost elasticity to pick up the tissues of the face and move them back to a more youthful position,” he says.

Usually (but not always), those most interested in a preventative facelift have already invested in plenty of non-surgical options, mainly fillers and injectables, which Mascaró says is often done to lift things. "After a few years of the surgery-free options, they don't see the same results they were initially noticing, so it becomes time to look for solutions that are a little more advanced," he explains.

Levine says that most patients curious about early intervention with a facelift are typically in their late 30s and early 40s, although some may be younger, and the procedure is not age dependent. “Instead, we are looking more for early signs of laxity so that these patients can look like themselves but refreshed and undetectable. They do not want to be too tight or pulled, but instead like their best possible self.”

Then there are the Ozempic patients, who have lost significant amounts of facial volume from the weight loss medication, causing skin laxity, muscle loss and a hollow, aged appearance. Doft says these facial changes can only be improved with a facelift. “Some of these patients are in their 30s, but for the most part, patients seeking a preventative facelift are in their 40s,” she shares.

So, is there an age cutoff where plastic surgeons consider a patient too young despite skin laxity and some mild signs of aging? Truth be told, it's less about age and more about bothersome signs of aging. "There are younger patients with genetically heavy necks that may benefit from a deep-plane neck lift at a younger age," Levine says.

How Preventative Facelifts Impact Future Cosmetic Procedures

One question Mascaró says his young facelift patients always ask is how long the initial one will last and how long it will be before they need to start thinking about doing something else. The tissues will continue to age from whatever point they are corrected, meaning that if you undergo a facelift at 41, they will age from a chronological age of 41. "Most people won't need another facelift for about 10 or so years, although they usually continue to do some minimally invasive treatments and procedures,” he says. “But overall, you're at a net positive when looking at the global picture of what kind of treatments you're doing in the aging process."

A facelift done early does not generally pose any implications or complications for future surgeries. The one caveat before deciding on future surgeries, according to Mascaró, is waiting until the skin has enough tissue laxity and loss of elasticity so that it is ready to be picked up again, which may not be until your late 50s or late 60s. If not, a premature facelift can cause noticeable scarring and a risk of injury to the nerves and deeper structures, especially if the surgery is done more aggressively. Naturally, you should only trust your face to an experienced board-certified plastic surgeon who has performed multiple preventative facelifts throughout their career.

The Bottom Line

The preventative facelift isn't going anywhere, especially as plastic surgeons see an influx of younger patients coming into their offices for early intervention. "My patients are thrilled to have a choice that moves them away from fillers," Doft shares. "There's still a lot of conversation regarding the risks and negative effects of fillers, which has many patients looking for a surgical alternative. They do not want an over-plumped face; sometimes surgery gives the most natural result." The goal of a facelift, regardless of what age it is done at, or any other cosmetic procedure, is always to look like you never did anything.