Years of sun exposure, pale skin, and a genetic predisposition to wrinkling might be just the factors that would lead someone to endure the risks and costs of a face-lift. But at 30 years old?
Plastic surgeon Dr. David Rapaport of New York had just such a patient, a young woman whose face, he explains, "was aging in an unfavorable way."
The majority of patients wouldn't undergo such plastic surgery until they're 40 and 50 years old, so encountering 30-year-olds who require face-lifts is unusual, despite what experts agree are wide differences in the manner in which individuals age.
Says Rapaport of his patient, "You need to look at each individual's physiology, and the best thing for her was a face-lift. There are very few people that need face-lifts in their 30s."
But on ABC's Good Morning America, Dr. Pamela Lipkin says that in her New York City practice, she is seeing more and more women in their 30s looking for a little nip and tuck.
"Collagen to fill out the wrinkles, fat injection to fill out a furrow," says Lipkin, "but at the end of the day, what they are really doing is filling out looseness. … And the best results come when you don't puff out the looseness, you get rid of it."
Rapaport, however, believes it all depends on the individual. "You age the way you age. There are plenty of people in their 60s that don't need a face-lift, while others age more prematurely."
The trend among 30-somethings, according to the American Society of Plastic Surgeons, are "quick fixes," minimally-invasive procedures to delay the onset of aging, such as Botox injections, chemical peels and micro-dermabrasion.
"Patients in their 30s are usually good candidates for more non-invasive maintenance treatments," says Dr. Greg Brahnam, director of plastic surgery at St. Louis University School of Medicine
"It is not uncommon to perform an eyelid tucks in this age group, as the excessive upper lid skin can have a significant hereditary component that drives patients to want something done sooner than the changes that occur in the neck and chin."
But, points out Dr. Charlie Thorne, a plastic surgeon at New York University Medical Center, such procedures may turn back the clock, but won't stop it. Face-lifts, for instance, last an average of five to 10 years.
"The aging process goes on," adds Thorne. You're going to look one day older the day after your face-lift. Suppose you look 60, and you had an operation that makes you look 45. In 10 years you'll look 55 instead of 70."
Distorted Self Images?
But some experts believe many young people who do undergo the procedure may have bigger problems than just sagging skin.
"Most patients under 35 who are seeking surgery at this age are unrealistic and obsessed with minimal deformities," says Dr. Scott Spear, chief of plastic surgery at Georgetown University Medical Center in Washington, D.C.
Agreeing is Dr. J. Regan Thomas, chairman of the division of plastic surgery at the University of Illinois at Chicago School of Medicine. He says the root of the problem may be inside the head, and not on the outside it.
"It would be a rare individual who has any facial anatomy or aging changes that would justify the procedure in that age group," says Thomas.
Many doctors flat-out refuse to do face-lifts on patients under 40.
"The issue centers around doing an elective surgical procedure on someone with minimal or insignificant indications at any age," explains Thomas. "Most people searching out face-lift in this scenario are likely having self-image problems and should be counseled accordingly."
With Patients, Is Older Better?
One practical reason doctors prefer to perform the procedure on older individuals is because they have fewer side effects, such as scarring.
"They [older patients] are the ones that form the best scars," explains Thorne. "Their skin is so shot, the scars don't have a tendency to spread. And they have wrinkles in which to hide them."
But there are special circumstances under which even those physicians who would normally object will perform such procedures on the young.
"There are patients with skin and connective tissue elasticity abnormalities that may be suitable candidates at an early age," says Dr. Richard Gliklich, facial plastic and reconstructive surgeon at the Massachusetts Eye and Ear Infirmary in Boston. "Although it's not common, it does occur."
‘Making Myself Happy’
For 35-year-old Darla Shine, gaining and losing 70 pounds during each of her two pregnancies had made her feel uncomfortable about the way her face looks, so much so that she is now considering a face-lift.
"I feel like I looked tired all the time, my face is fatter, it's hanging down. I just don't look the way I used to look," says Shine. "People have said 'You look good, you look great the way you are,' and it sounds insane, and I may be totally vain in doing this procedure, but it's about me, it's about making myself happy."
But she adds: "If you have someone unhappy, feels ugly, and they think a face-lift is going to change all that, you should stay away from that patient, because no matter how good the result is, that patient still won't be happy."