Facelift Prior to Menopause: Does it Lead to Better, Longer-Lasting Results?

I try to follow the advice I give to my school-age children. When I explain how flashy, seductive advertising between their favorite shows is designed to capture their attention and encourage them to ask us parents to buy the products on offer, they look at me incredulously. They cannot imagine not taking whatever product is being marketed to them so effectively at face value. I implore them to ignore this advertising.

Marketing works, especially when it is couched in a professional manner meant to seem authoritative. I see this method of marketing most frequently in my field of facial plastic surgery with the “What’s Trending” articles by health, beauty, and wellness publications. These articles often quote plastic surgeons and dermatologists who make declarative statements devoid of nuance. One such “trend” advertised is the concept that undergoing a facelift prior to menopause leads to better, longer-lasting results.

There is No Rigorous, Quantitative Way to Determine Whether a Facelift Prior to Menopause is Superior to After Menopause

Will a facelift prior to menopause lead to better, longer-lasting results? While a reasonable belief, there is no research that suggests an ideal window to undergo facelift surgery and neck lift surgery. There are simply too many other factors that affect age-related changes to the face and neck that are of equal or greater importance.

These factors confound any study that could be done; meaning, it would likely be difficult to determine whether menopause itself – the level and length of time of estrogen deprivation – causes a facelift and neck lift result to be worse or last for a shorter period. Furthermore, what exactly could a clinical researcher measure to determine whether a facelift and neck lift are better or last longer? What would these results be compared against? These features are qualities to be judged by other humans, which makes doing rigorous research in facial plastic surgery so difficult.

Estrogen Levels Influence the Quality of Facial Skin

Estrogen does influence facial skin.  A decrease in circulating estrogen is associated with accelerated thinning, laxity, wrinkles, and drying of the skin. Also, decreased estrogen may impair skin healing. However, estrogen levels drop gradually during menopause. As a result, skin changes associated with menopause exist on a spectrum rather than falling off a “cliff” at a specific point in time after menopause. It is likely more important whether a patient is early post-menopause – within approximately ten (10) years – or late menopause. It is also worth considering whether a patient is taking Hormone Replacement Therapy (HRT) or not within that early window. This is because it may be that changes to the skin associated with menopause are not as severe for patients early post-menopause who have maintained their estrogen levels through HRT.

Lifestyle Factors are Likely More Influential Than Estrogen Levels on Skin Quality

Lifestyle factors are likely a much more important influence on the effectiveness and longevity of a facelift and neck lift. These factors include:

• Genetics
• Cumulative unprotected sun exposure
• Smoking history
• Alcohol use history
• Diet
• Exercise

Excess sun exposure and any smoking and/or alcohol use history can adversely affect the quality of the soft tissues of the face. Poor diet and exercise can not only do the same but also lead to excess weight which, when deposited across the face and under the chin, can mask what would otherwise be excellent surgical results.

Deeper Tissue Has A Greater Impact Than Skin on Expected Surgical Results

The most important thing to understand about facelift surgery and neck lift surgery is that skin quality is not the primary influence on the approach taken or expected results when the most modern, gold-standard surgical approaches are used. This is because with deep plane facelift and neck lift surgery a composite flap that includes not only skin but also fat, muscle, and fascia released from their deeper attachments and secured to the incisions under little-to-no tension. In contrast, older facelift approaches focus primarily on stretching and removing skin. As a result, excellent, natural-appearing results are achievable regardless of the skin’s appearance.

The skin changes associated with menopause simply demand consideration of other, complementary procedures to improve the appearance of the skin after surgery, such as:

• Laser skin resurfacing with nano-fat and platelet rich plasma (PRP)
• Fillers
• Neuromodulators like Botox®

The Idea of a “Preventative” Facelift and Neck Lift is a Myth

Aesthetic medicine too often oversimplifies complex biology and packages it into declarative marketing language. Individual anatomy, regardless of age or menopause status, matters most. Complex three-dimensional changes to the face and neck can precede the skin changes that often accelerate with menopause. However, early prior to these changes is unnecessary. I believe the idea of a “preventative” facelift is a myth. At the same time, I believe that a pre-menopausal facelift is appropriate and beneficial in the right patient when changes in the anatomy, however significant or insignificant, demands it. That determination requires good physical examination during the consultation process.

The Best Time to Undergo a Facelift and Neck Lift is Patient-Dependent

The best time to undergo a deep plane facelift and deep neck lift is when:

• There are visible changes – however significant – to the face and neck
• Healing is optimized by discontinuing alcohol use, avoiding tobacco or nicotine, and treating low estrogen levels if post-menopause but only if indicated to treat other, non-aesthetic symptoms
• The patient is appropriately motivated for personal reasons as opposed to external pressure
• The patient has reasonable and appropriate expectations about the results

The explanation above does not fit neatly into a piece of marketing material. The answer “it is complex” never does. However, such nuance is increasingly being demanded by the increasingly intelligent, informed public.