- Istanbul. Shopping two days after a deep plane facelift, head still wrapped.
I won’t name names (nor diagnose from afar using a photo taken with a long-lens camera). But two of the questions that occurred to me after seeing that photo, day two after a deep plane facelift procured through a medical tourism agency, are ones I get asked all the time here in El Paso.
The story ran in Fashion Times UK and the Daily Mail last week (I’m sure there were others): 39 y/o Bachelor Australia personality flies to Istanbul for a deep plane facelift and is then photographed out and about (apparently shopping) on day two with her head wrapped. No surgeon named.
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If you’re only 39, why on earth would you get a deep plane facelift?
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Who’s taking care of you in those first two weeks after a facelift if your surgeon is on another continent?
Thirty-Nine Is Not Too Young. It Is the Whole Point
Why first. Back when I finished my fellowship, a 39-year-old asking for a facelift got tretinoin and a kind smile. Not now. A young patient saw me this fall about her eyelids and we ended up talking about the lift. I told her this, give or take a word.
“As for the lift, the one that’s most natural and lasts the longest would be the ponytail. It’s like a mini, but I don’t like to say mini, because mini is like mini results. It is a deep plane, but with minimal scars.”
“I mention it because, obviously, you’re young, but with this surgery you’re going to look 10, 15 years younger. The good thing is that at this age we can go back to the late twenties, late thirties, and start over. Then ten years after the surgery, we can do it again and go back to the thirties when you’re in your fifties. The sooner we do it, we kind of lock in a younger age. If we do nothing, it ages a little faster. That’s just for you to consider, not something you have to do.”
I want to underline that last line, because it gets lost. At 39 this is an option on the table, not a sentence. Nobody has to.
So why am I having this conversation with people in their thirties at all? “The reason we’re seeing this increase exponentially is that patients are noticing signs of facial aging earlier, or they’ve been on GLP-1s and have had accelerated aging from fat loss in the face and skin sagging.”
And then there is the arithmetic, which is the part people seem to like best. “If you get it at forty, you’re probably going to look like you’re in your early thirties, or even late twenties. But time keeps moving forward, so if we repeat the procedure ten years later, we take you back to that earlier stage of yourself.”
Which Deep Plane, Though
“Deep plane” tells you the layer the surgeon worked in. It does not tell you where the scars are. “The differentiator is how much excess skin there is. If there’s substantial excess skin, then we do a deep plane open facelift with an incision in front of the ear. If there’s not a lot of excess skin, we can get away with doing everything through the incisions behind the hairline.”
A ponytail lift, also called an endoscopic deep plane facelift, leaves its scars inside the hair. It is my go-to conversation with most patients under 45 because there’s typically not a lot of extra skin at that age. Will it look pulled? That’s the question I can set my watch to. A patient asked me exactly that in September.
“I think the deep plane lift and the endoscopic deep plane lift are great procedures, which create very natural and long-lasting results, and we’re seeing patients completely avoid the noninvasive procedures and go straight to the surgical procedures early on.”
What Day Two Looks Like, Anywhere
Shopping in Istanbul on day two after a deep plane facelift? Not shocking to me, honestly. Facelift recovery is physically easy and mentally hard, and I say so before every one of them. “The surgery itself takes about six hours. It’s general anesthesia, and you go home the same day. The good thing about this face surgery is there’s no pain, so the physical recovery is easy. The hard part is you’re going to be swollen, there’ll be some bruising, you’ll look in the mirror and get a little impatient. So it does take about two weeks to start looking good and feel comfortable with other people seeing you. If you have a social event, I’d say six weeks is when you start looking your best. You’ll have a drain that comes out back here. It usually comes out at five days. We remove it, not you.”
Our pre-op nurse says the same thing to every facelift patient before surgery: “So the majority of our patients, around week 3 to 4, they’re regretting what they did. I like to let you know, because once you remember what I tell you when you’re healing, you’re like, okay, she did tell me.”
So the picture of her out with bandages on day two makes sense to me. Day two was never the part I worry about.
The Problem Is Day Five Through Fourteen, and Who Is There
Most of the patients I operate on live out of town, so I have a spiel for this, and here it is. “To be here in El Paso, I recommend staying one week so we can remove the stitches, check that everything is fine, and do the treatments. We have a light treatment called Elixir MD that speeds the recovery almost by double, so that helps you get back to work faster.”
“After seven days here you can go home, and all the follow-ups can be virtual.”
Then there’s the practical stuff. My rule for out-of-town patients is a week near me. I pull the drain myself on day five, take out the sutures, and feel for any fluid under the skin, then you go home and spend two weeks being patient. A medical tourism package has to answer for all of that. Sure, the surgeon may do a beautiful facelift (check that too), but who’s going to remove the drain? Who examines you when there’s a question about swelling on day six? Who reassures you when one side is a little more swollen than the other on day nine and you’re sure the surgery must have gone terribly wrong? And what about the added risk of blood clots and swelling that comes with a long flight in the first week? No help from the booking agent for that, either.
When They Come Home to Us
Every so often one of those patients ends up in my office, which is why I wrote about aftercare for people who had surgery elsewhere last month. The short version of how that goes: “After their surgery, they still need aftercare. Whether it is routine or not, they find themselves in a bind because they cannot easily travel back to see their surgeons.”
“Most surgeons do not accept patients from other surgeons, which makes it difficult for these patients to obtain optimal treatment. We are here for patients, and we are available if we can help.”
What I need from them: “Documentation of the operative report and drain output, as well as any implant cards, is beneficial, but oftentimes not available immediately.”
And what I will not touch early, no matter how much someone wants me to: “In the early stages, we really cannot revise any of the surgery itself.” For the ones who are already unhappy, “patients are usually told to wait until healing has been achieved, which can vary depending on the procedure from three months to a year.”
One more thing, because people flying home tend to forget it. The go-to-the-ER list is the same in every country. “In terms of when to go to the ER, this is very clear, and the patient should already have these instructions from their original surgeon. This includes any changes in vital signs, such as low blood pressure, tachycardia, which is a high pulse rate, fever, lightheadedness, or fainting; redness, purulent discharge, changes in the color of the drain output, specifically if it becomes white, yellowish, or creamy; a fluid collection that keeps growing, shortness of breath or chest pain, swelling in the legs or tenderness in the calves, a breast that suddenly gets larger and painful, or uncontrolled bleeding.”
What I Would Say to Her, or to You
I hope her recovery goes smoothly. Most do, even at 39. The six-week mark will give you a good idea, but a year will show you the final result. I discussed what a settled facelift looks like in my post about Kris Jenner, and the ponytail lift in my facelift you can’t see post.
39 and thinking about it? Ask these questions first, before the price: Which deep plane? Can I hide the scars in my hair? Who takes out the drain, and when? Who do I talk to if, in the third week, I’m freaking out that my reflection looks totally messed up?
The surgical side of this (candidacy at 39, the two deep planes side by side) is on Agullo Plastic Surgery, and the recovery side (LED light, the aftercare package) is on Southwest Plastic Surgery.
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of plastic surgery at Texas Tech University Health Sciences Center. I trained in the ponytail lift at the Ponytail Academy (the intermediate course in Pittsburgh, the advanced one in Santa Monica), and I do these every week in El Paso.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com. Find me @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
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