Notes from the OR

The 50something facelift, menopause as influencer, and the hot-button issue some surgeons can't stop talking about

Hello and welcome back!

Are you guys watching Pacey, aka Joshua Jackson, in Doctor Odyssey? In the last episode, it was Plastic Surgery Week aboard the Odyssey—a recovery cruise for the wealthy turns dark—and amid the drama of necrosis, sepsis, frostbitten breasts, and lost noses, there was a very specific reference to: the deep plane facelift. Does the Hulu namecheck mean this surgery has officially achieved household status?

As the facelift continues to captivate, it seems there’s always more to say—even if it is, in a way, more of the same.

It is uncanny the number of surgeons who have—completely unprompted, during interviews on unrelated topics—detoured our conversations to tell me about the difficulties they’re encountering in facelift patients who went all-in on injectables and energy-based tightening treatments prior to surgery. As loyal readers know, I’ve covered this topic before (exhibits A, B, and C), but wow, the outpouring of anecdotes of late has been unreal. (If you’re new here and have no idea what I’m talking about, please consider scanning this for context.) I’m hearing these stories from unexpected sources—like, these aren’t just social-media doctors looking to push a clicky narrative or dump on nonsurgicals for fun. In many cases, they’re academics and educators who are disturbed by this trend and genuinely want to help patients make smarter, more informed aesthetic decisions.

One example: Patrick Byrne, MD, the chairman of the department of otolaryngology-head and neck surgery at the Cleveland Clinic, told me about a facelift patient he operated on a few weeks ago, who had “a lot of fibrosis, basically scar tissue, and challenges in the tissue plane of her neck.” After surgery, the woman remembered that she’d had a radiofrequency (RF) tightening procedure a couple years back. “That can negatively affect the success of surgery,” says Dr. Byrne. Especially when overused, deep RF can reportedly cause scarring, fat loss, and reduced blood flow to the skin.

Skeptics insist that this phenomenon of nonsurgical treatments interfering with surgery is anecdotal—and, thus, unproven—because there aren’t many reliable studies in the medical literature confirming surgeons’ experiential claims. Fair point, but I don’t think that invalidates what surgeons are seeing in the OR, day in and day out. Do you? Should we turn a deaf ear to those who are routinely operating on human faces and seeing the effects of these treatments? Anecdotal or not, shouldn’t every provider inform every patient they treat of the potential for select procedures to make facelift surgery and recovery longer, harder, and less predictable?

I hope you haven’t completely tired of this topic, because a) it’s becoming increasingly more relevant for reasons I outline below and b) when surgeons share their insights and advice on this subject, I immediately want to pass them along, even if it means veering into broken-record territory.

For those still reading, thanks, and here are some intriguing observations from experts, which seem to correlate the rise of the 50something facelift with the uptick in surgeons reporting anomalies that they link to prior tweakments. My fellow Gen Xers: Let me know if any of this resonates.