We have all done it – stood in front of a mirror and pulled back our faces. We survey and sigh at the inevitable sag southwards and then get on with the day. But for some, the idea of reversing facial ageing persists and they undergo surgery to get that lifted effect.
Facelifts, once the preserve of movie stars and wealthy socialites, are going mainstream, even in Ireland.
Facelifts are surging in popularity here, but as the vast majority are carried out in private facilities by private surgeons, it is hard to quantify how many are done annually.
A study in 2019 reported 89 full facelifts were carried out here that year, and since 2022 the popularity of the procedure has escalated.
Kris Jenner ‘doesn’t look like a 35-year-old’, Hanson says
Social media has driven the renaissance of facelift surgery. Not only are celebrities like Kris Jenner, Denise Richards, Marc Jacobs and Katherine Ryan undergoing facelifts, they are documenting them on Instagram.
Their endorsements have made American surgeons like Andrew Jacono and Steve Levine into media stars.
Levine reportedly did Jenner’s and Brad Pitt’s facelifts, while Jacono operated on Marc Jacobs and Paul Nassif of Botched.
Kathryn Thomas’s recent RTÉ documentary, Young Forever: The Death of Ageing? examined the tools now used to remain youthful.
One method explored was a deep plane facelift carried out by Richard Hanson, a pioneering surgeon who has brought the procedure to Ireland and performed 40 facelifts in the past year.
So, what does deep plane rejuvenation involve?
Hanson reveals first that Jenner’s facelift was not what has been reported.
‘She didn’t get a deep plane facelift, she had a SMAS-ectomy,’ he reveals. ‘So her big result is her neck and the jawline, that’s what really rejuvenates her.’
The face consists of five layers, Richard explains, comparing your skull to a hand and the layers to five gloves, one on top of each other.
These are the skin (epidermis and dermis); subcutaneous layer (superficial fat); facial muscles and SMAS; retaining ligaments and spaces (deep fat); and periosteum and deep fascia.
How deep the surgeon goes with your facelift can determine the extent and success of the results.
Denise Richards has gone under the knife
So what are the different options? A facelift is not a standard single surgical procedure but involves a range of techniques targeting different tissue layers and delivering different results.
In simplest terms, there are four types: the traditional skin-only facelift involves the removal of excess skin without addressing the underlying support structures.
It can provide temporary tightening but the results can be short lived with a taut appearance.
The SMAS facelift targets the superficial muscular aponeurotic system, the third fibrous layer beneath the skin.
During surgery, this layer is lifted and repositioned to improve facial contours, giving longer-lasting results than a skin-only lift.
It involves sub-facial dissection, lifting a deeper layer and adjusting and suturing deeper tissue.
However, it works above the deeper facial ligaments and doesn’t fully release the facial structures responsible for deeper sagging.
The mini-facelift is a less invasive procedure for the early signs of ageing.
It involves a smaller incision and more limited repositioning of the facial tissue, focusing on the lower face and jawline. Its effects are typically more short-lived and subtle.
Then the deep plane facelift works beneath the SMAS, on the fourth layer, releasing deeper ligaments and lifting the deeper tissue of the face as a single unit.
It addresses the structural descent associated with age and facilitates a more comprehensive and natural repositioning of the midface, jawline and neck. The skin isn’t pulled separately so there’s no unnatural tension and a softer effect is achieved.
While social media has popularised plastic surgery, it has also created extremely high expectations about the level and speed of transformation.
‘I was at a conference in LA last November and there were people that would know Kris Jenner, and they would say that they’ve seen her and that she still looks like a 70-year-old with a good facelift. She doesn’t look like a 35-year-old.’
Surgeon Richard Hanson has performed 40 facelifts in the past year
The heavy application of filters to facial imagery often distorts perceptions of what is possible, he acknowledges. However, he is open about what a deep plane lift can achieve, and what it can’t.
‘If they’ve unrealistic expectations, you just don’t do it,’ he says.
‘As you get older, there’s a few things that happen. Obviously your collagen goes down, your skin tone changes, but you get a big laxity and gravity pulls things down, so everything starts to sag. You lose a little bit of volume, so you start to deflate a little bit, and then your bone structure is absorbed so it doesn’t support everything as well.
‘As you age, there’s a strain in your face that people can see. What the deep plane facelift does is it tries to address that strain. It just tries to take the strain away and we’re looking for a harmony in the face. We’re not looking to like pull everything too, too tight. We’re just looking for a re-set.
‘Most of my patients who’ve had a facelift, they’ll be back out socialising in four to six weeks and people won’t be able to put a finger on what they’ve had done. They’ll just say, “You look great”.’
The stigmata of traditional facelifting techniques – like a pulled ear, stretched face or the change in the pull of the neck – are avoided.
Patients look like themselves but just really refreshed.
When he first started doing facelifts, Hanson didn’t find a huge demand here for facial surgery. Then at a conference five years ago, he came across the deep plane facelift techniques used by Jacono and had his Eureka moment.
Hanson’s extensive experience operating on facial melanomas involved removing nodes which necessitated incision, dissection and facial reconstruction, so he felt in familiar territory with the deep plane techniques.
He studied the deep plane method with the best surgeons and has offered it for the past five years. Mastering it involved observing surgeries, practising dissections on cadavers and then being critiqued. He continues to do this type of training with industry figures like Mike Nayak, Guy Massry, Dominic Bray, Elizabeth Chance and Ben Tallei.
As well as surgical skill, Hanson says there is artistry involved in facelifts. ‘There has to be an artistic eye,’ he says.
‘You have to work out where you do your pull because you’ve got to lift the face up and that’s where the real artistry comes.’
He concedes he isn’t looking for perfection or symmetry. ‘All we want is to just give harmony and a re-set,’ he says. ‘I’m trying to find the relaxed person in them.’
For a surgeon, he is refreshingly candid – and has some advice on fillers.
‘Filler does not lift a face,’ he insists. ‘You’re adding volume to a problem where gravity has pulled everything down and you’re putting more volume in to pull it down.
‘It never, ever goes – this is the scary thing. I’ve a ton of pictures where I’ve taken all the filler out of a face and people have said, “Oh, I had filler done eight years ago”.’
He cautions too about the aggressive marketing and upselling in the aesthetics industry. Incentivising more procedures via pricing should be a red flag. He says that repeated use of aggressive lasers and fillers can end up ‘just destroying your face’.
This in turn can have a profound effect on skin healing.
‘Then when you get a facelift, it’s really difficult, your recovery is really, really slow,’ he says.
‘All your filler goes into your lymphatics, your blood supply is destroyed in your skin because of the lasers, you’re going to have tons of complications.’
If a client came to him who had loads of lasers, thread lifts and fillers, he probably wouldn’t do a facelift on them.
‘Like a tiny bit of filler is great, but filler is not regulated,’ he says.
‘People are just putting loads and loads of filler in and it’s just bad. You don’t have to be a doctor to do filler, but you need to be a doctor to dissolve filler if there’s a complication. It’s just a big no-no.’
As is smoking.
‘I wouldn’t operate on a smoker,’ he says. ‘Nobody would. If you’re a smoker you’ve to stop smoking for six weeks before surgery.’
A patient who admitted she would be drinking on holiday in the week before her operation was taken off his surgery list too. While the trend in the US is for ever-younger facelifts, Hanson says that most of his clients are in their 50s and 60s — though he does admit operating on people in their 40s. ‘If a person is the proper candidate, nothing beats surgery,’ he affirms.
Today, he says, pain is not an issue — but it’s not risk-free. As with any major surgery involving a general anaesthetic, there are potential complications.
Death, a cardiac issue like a heart attack, or problems with breathing or a clot are the big ones. Scar tissue takes three months to heal but tends to be minimal. Haematomas under the skin and necrosis can sometimes occur and involve going back to the surgeon immediately.
Swelling and nerve problems, often temporary, can present post-surgery. Overall, however, most people are home the day after the operation.
He offers clear advice about choosing a surgeon.
‘You have to be confident with your surgeon,’ he says. ‘The surgeon has to be able to answer all the questions, the surgeon has to be able to show you pre and post-op pictures, the surgeon has to be able to tell you how he’s going to manage a complication. Complications happen.
‘Even the best surgeon in the world will have complications because there’s a 1 per cent chance of getting a haematoma.
‘If the doctor can’t manage the complications, that’s poor,’ he stresses. ‘If you haven’t done a complication, you either haven’t done enough or you’re lying.
‘You should be able to look at their accreditations – there’s a lot of people out there say that they’re on this, that and the other [list] and they’re not. There’s lots of people that have clinics in Dublin that say they are a plastic surgeon or a cosmetic surgeon, and they’re not.
‘There’s lots of people doing facelifts that aren’t trained in facelifts. They’re doing some haphazard kind of thing that they think they’re going to get away with under local anaesthetic in a back room. There’s a lot of people that are unhappy with their facelifts.’
Hanson says that he tells everybody who comes in that they don’t need anything but if the patient genuinely feels they want it, then he will create a surgical plan. A ballpark figure for a deep plane lift with him is €20,000 to €30,000, which is a fraction of the cost in the US but still a major financial commitment.
Some say that a deep plane facelift can last up to 12 years but that isn’t conclusive. Regardless of longevity, you need to trust you surgeon because your face and your future are in their hands.
So step back from the mirror to consider the risk/reward ratio before you commit.
Your face may not be your fortune, but it is uniquely yours.
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