At what age range should facial rejuvenation surgeries be performed?

When is it too early?

When is it too late?

Is there an ideal timeframe?

We receive these questions frequently.

And yes, there is an ideal age range.

With today's techniques, we can say it's between 45 and 55.

However, we perform surgeries on patients both younger and older than this ideal age range. Planning is tailored to individual characteristics. In my article titled "Is it too early for a facelift?" I discussed why facial rejuvenation surgeries are performed with various reasons and techniques in younger age groups. In this article, I will review the fundamental characteristics of facial rejuvenation surgeries performed on individuals beyond the ideal age range.

Facial rejuvenation, as the name suggests, is a procedure to make aging faces appear younger. Advanced age alone doesn't prevent surgery. However, there are many factors that influence and deviate from the ideal in terms of technique, psychology, aesthetics, medical aspects, and psychology for surgeries performed on older individuals.

By "advanced age," we generally refer to individuals above the age of 65.

Patients in this group have wide individual differences due to genetic inheritance and their prolonged lifespan. Nonetheless, we can mention some common features of this group.

 

 

In the advanced age group:

1. Almost always, there's comprehensive aging affecting the entire face. We deal with multi-layered aging levels, from the forehead to the neck, eyelids to the mouth area, involving skin surface to bone. Achieving a good and natural result in this category requires a plan that encompasses the entire face. Inadequate surgical plans can lead to transitional deformities between operated and non-operated facial areas. Sometimes, even without these deformities, a visual contrast might arise between the area that looks good and the area not included in the treatment plan (e.g., youthful cheeks and an aged neck). Surgery plans covering the entire face and all layers from deep to superficial typically take longer and have higher costs. Moreover, patients in this age group might not accept surgery plans covering the whole face. Even if some agree, their health conditions might not permit it.

2. Patients in the advanced age group frequently have accompanying health issues. Hypertension, heart diseases, diabetes, and arterial stiffness are common. These accompanying conditions influence surgical planning. For instance, performing all the surgeries mentioned in the first point in a single, long session can increase the risk of systemic complications like embolism, heart attack, atelectasis, and hypothermia. If the patient has no accompanying health issues, studies show that longer surgery times do not necessarily increase complication risks. However, in the presence of accompanying health issues, surgery might need to be divided into sessions. These health problems also increase the likelihood of surgical complications. For example, hypertension increases the risk of bleeding/hematoma after surgery, while diabetes increases the risk of necrosis/tissue circulation disorders. These accompanying health problems also affect the choice of surgical technique. For patients with hypertension or on blood-thinning medications, despite the fact that multilayered or deep neck shaping techniques might yield better aesthetic results, they might not be chosen due to the risk of bleeding. In such cases, surgery might have limited impact on surface wrinkles or deep neck issues. In the advanced age group, prioritizing patient safety might lead to using a less-than-ideal technique or treatment scheme. With accompanying health issues, both the patient and the doctor might need to accept results below the ideal.

3. The quality of tissue you work with and its healing potential might be below ideal in the advanced age group. Achieving a good result in facial rejuvenation surgery requires good tissue quality, which preserves the result's permanence. Not all fabrics are suitable for making a tuxedo. While you can remove sagging from the face and improve the positions of soft tissues relative to the skeletal structure, you cannot restore the internal quality of the skin and soft tissues to their youthful levels. Regenerative treatments that promote improvements at the tissue level can be included in the treatment plan, but often, the benefits achieved fall far short of patients' ideal improvements. Treatments like fat grafting, stem cell therapy, and cultured fibroblast therapy indeed have a delaying effect on aging. When used as maintenance treatments, they can slow down aging. However, their ability to reverse tissue loss caused by aging is quite limited.

4. Unrealistic expectations are common among patients in the advanced age group. An individual who hasn't taken any preventive measures for their face over 75 years can easily show you a photo of themselves at 45 and say, "I want to look like this." Even though patients in the advanced age group might not accept holistic plans, they might expect holistic results. While aiming to change their appearance through surgery, they might not want to see a different face when they look in the mirror.

5. Communicating with patients in the advanced age group is slightly more challenging. Often, there are "difficult patient relatives" who speak on behalf of the patient, intervene in the decision-making process, yet avoid taking any responsibility. Patients in this age group might not fully trust their doctors because they are often older than their doctors. Physicians might be the same age as the patient's child or grandchild and might not be able to change the patient's fixed ideas with rational explanations.

It's beneficial for any patient considering facial rejuvenation surgery at an advanced age, as well as their family members, to be aware of these points. Up to this point, what has been written might paint a bleak picture for facial rejuvenation surgeries at an advanced age. However, I must also mention that some of the patients I've enjoyed knowing and treating the most in my career fall within the age range of 65 to 75. I've encountered remarkable individuals in this age group with tremendous life energy and accumulated wisdom, who, figuratively speaking, put the younger generation to shame. I'm proud to say that I have dozens of patients whose age you can't accurately guess by looking at their faces, bodies, attitudes, or attire, and I admire them. The generalizations in this article do not bind individuals in any way. I also don't hold any biases against candidates who desire facial rejuvenation surgery, whether they're under 45 or over 65.

For more detailed information on facial rejuvenation treatments in the advanced age group, feel free to get in touch with us.

Stay well,

Stay beautiful,

O.B.