The Facelift's PR Problem: Why Plastic Surgeons Say the Stigma Is Still Very Real

Since that stop-the-presses moment last summer when Marc Jacobs surprised his 1.6 million followers with a shot of his freshly lifted face—bandages thickly wound, drains dangling like avant-garde earrings—countless words have been written about what his act of transparency might mean for plastic surgery. Citing not only the designer's decision but a handful of other celebrities who've publicly discussed their Botox or buccal fat removal treatments, various outlets have declared plastic surgery is no longer taboo.

To their point, celebs are opening up more about cosmetic procedures. It's not unusual to see familiar faces iced with numbing cream, awaiting injections or laser treatments. Many of the women from the Real Housewives franchise have become famous for broadcasting their nips and tucks. The occasional influencer will discuss their rhinoplasty or post-baby lipo. Each admission moves the normalization needle, no doubt. But do recent events signal a sweeping destigmatization of plastic surgery? A rewiring of age-old perceptions, especially as they relate to the facelift?

It's a tall order for a procedure that's become emblematic of plastic-surgery stigma itself. "When people talk about 'bad' plastic surgery, uniformly, they pull up on their faces, simulating with their hands an exaggerated, windswept facelift," says Dr. L. Mike Nayak, a board-certified facial plastic surgeon in St. Louis, Missouri. The facelift may very well be the most maligned and misunderstood procedure in all of aesthetics—and what a hulking weight to bear. Our collective qualms about the facelift are "a big hurdle I deal with on a day-to-day basis," notes Dr. Sinehan Bayrak, a board-certified facial plastic surgeon in Newtown Square, Pennsylvania.

I'm fascinated by the facelift and the feelings it inspires. As an aging female who writes about plastic surgery for a living, I've spent a fair amount of time contemplating the procedure. I haven't had a facelift (yet) or performed one (clearly), so I can't claim intimate knowledge of the operation, but I do possess a respectable degree of familiarity. To me, what's even more compelling than the nitty-gritty anatomical maneuvers involved is their combined ability to foil time's attempt at slowly but surely rearranging our faces—dropping our cheeks, scalloping our jawlines, reshaping our necks. Age is the ultimate identity thief, I'm convinced, and the facelift offers a powerful way to defend against it for those who are so inclined.

But my vantage point is decidedly unique. I spend my days talking to plastic surgeons, learning their techniques, and absorbing their insights. It is their content that comprises the bulk of my social media diet. I eat it up, sharing the very best morsels with my followers, a group of like-minded individuals to whom this is all very normal. Inside the plastic-surgery bubble, injectables are used like makeup—to conceal, contour, and enhance. Breast augmentation is deemed less daunting than dental work. Nose jobs are as utilitarian as braces. But this normal is not the norm, I realize. To accurately gauge the current state of facelift stigma, we must consider the broader spectrum of public opinion and all that informs it.

Stigma Still Affects the Facelift 

The plastic surgeons who contributed to this story agree facelift stigma still unequivocally exists across the country. "I see it not only with my patients, both young and old, but also with colleagues who've asked me to do their faces," says Dr. Catherine S. Chang, a board-certified plastic surgeon in Beverly Hills. "They don't want people to know they're having a facelift."

Dr. Bayrak, who practiced in Miami before settling in Philly, has long noticed a "palpable shift" in some patients' demeanors at the very mention of the word "facelift" during consultations. "It's almost like they're shocked when I recommend it," she says. Yet, they're generally unfazed by talk of brow lifts, blepharoplasties, and lip lifts. Dr. Bayrak believes the facelift's unsavory connotations are at least partly responsible for the rise in trademarked terms for the surgery—like the Vertical Restore or the Auralyft. "The temptation to call it something else—to repackage it into a more palatable form—is incredibly high," she admits. 

According to our experts, facelift stigma is strongest among certain demographics. "Women of color have had a hesitancy around plastic surgery, in general, for a long time—it just wasn't something they thought applied to them," explains Dr. Amaka Nwubah, a board-certified plastic surgeon in Nashville, Tennessee. While she's seen attitudes shift slightly regarding breast and body surgery, she says, stigma is still high around facial surgery in communities of color.

Men are typically more private about facelifts than women, surgeons say. But it's (no surprise) females who bear the brunt of society's scrutiny, according to a recent study in Australia. "In planning to undergo plastic surgery, these women are perceived as less warm, moral, competent, and human," the researchers state. By deciding to pursue a cosmetic procedure and voicing that decision, their character is questioned before they even go under the knife.

Believe it or not, age isn't a constant variable in the transparency equation. One might assume mature patients are discreet or younger folks are open books, but the reality is far more nuanced. Dr. Chang performs a patented version of the facelift called the Bijoux Lift—a minimalist approach that targets early jowling on those in their 20s and 30s. While these are some of her happiest patients, she says they rarely talk about their results or allow her to post their photos on social media.

Behind the Stigma

We live in an era of oversharing, where our actions garner likes. So why aren't facelifts making the Instagram grid? When it comes to the social acceptance of cosmetic treatments, Dr. Bayrak says, "the facelift is definitely straggling behind." She attributes this mainly to the procedure's troubled past—"the incredibly obvious, incredibly pulled facelifts of yesteryear," she says. Indeed, every surgeon interviewed said people tend to conflate the facelift with dated outcomes and ideas. "There is this very old and unique stigma around the facelift because historically, the procedure has been associated with facial distortion when performed carelessly or excessively," says Dr. Danny Soares, a board-certified facial plastic surgeon in Fruitland Park, Florida.

Those impressions have been hard to shake—even today, with "natural" being the adjective of the hour. Dr. Steven Levine, a New York City board-certified plastic surgeon, says despite the fact "people who have facelifts are almost universally happy," the facelift patient's greatest fear is they're going to wind up looking unlike themselves and will then be judged for having surgery.

Board-certified facial plastic surgeon Dr. Michael Somenek also sees the past holding people back. The facelift-curious patients who visit his Washington, D.C. office will commonly reference someone in their lives who had a lift decades ago and was left unrecognizable. 

However, the facial aging process—the layered anatomical changes that occur over time—wasn't well understood back then. Additionally, "surgeons lacked all of the tools we have today, so they would rely on facelifting for everything," Dr. Soares explains. They'd surgically lift the face—often tugging and tailoring the skin only—without addressing volume loss (through fat grafting), wrinkles, and sunspots (with Botox and lasers), thereby creating some odd or dissonant effects. Faces looked tight but still weathered and gaunt, which prompted "some individuals to undergo multiple facelifts in a short period," he adds. 

Such scenarios damaged the facelift's reputation and that of the patient, turning her into a cliché that modern men and women still actively recognize and resist. "[Most] of my facelift consults start the same way," Dr. Levine tells us. Whether he's meeting a teacher, an actress, or a CEO, it goes like this: "Hi, Steve. Nice to meet you. I want to let you know I am not your usual patient. I don't wear a lot of makeup. I don't look in the mirror. I am not vain, I promise." He says the facelift patient's fear of being found out often stems from not wanting to be labeled as vain.

The shame plaguing the facelift isn't always rooted in vanity alone. There are undercurrents of ageism, as well. In a youth-obsessed society, there's something exquisitely vulnerable about seeking a facelift—an operation performed for no reason other than to correct signs of aging. "It's like publicly declaring, 'I am an old person,'" says Dr. Nayak—which is ironic, he adds, since people are having this surgery because they don't identify as old. "They're intellectually and emotionally young, and they want to be young in appearance too," he says.

There still is a sense of embarrassment that comes with qualifying for a facelift for some. At almost 45, I can relate. Merely entertaining a facelift—this mega intervention, the biggest gun in the beauty arsenal—seems to imply that I have aged imperfectly, ungracefully, or at least not as well as, say, Reese Witherspoon, who, at my age, could double for her 22-year-old daughter. 

The Celebrity Effect

This brings us to the final piece of the stigma puzzle. By and large, "Celebrities continue to deny their facial work," says Dr. Somenek. "So many of them have had facelifts and neck lifts, but they don't own up to it." Some still attribute their fold-free skin and snatched jawlines to products or habits that are utterly inconsequential. Dr. Chang recently saw one of her patients on TV crediting a facial roller for her flawless visage. While everyone has a right to privacy, she notes: "when celebs are constantly saying they've never done anything, and it's obvious they have," they unwittingly make plastic surgery seem like a dirty little secret.

However, can we blame them when Hollywood itself rarely casts plastic surgery as a protagonist? A 2021 study exploring how the specialty has been portrayed in cinema over the past 100 years found most films present aesthetic interventions, plastic surgeons, and patients in a negative and unrealistic light. Consciously or not, we've all likely been swayed by these biased depictions.

"There is, without question, a stigma in American culture attached to cosmetic surgery and a hidden condescension toward patients undergoing these procedures," board-certified plastic surgeon in Anaheim, California Dr. Saba Motakef said in a 2014 article in Plastic and Reconstructive Surgery. "If culture's tastemakers [were] more transparent about their decisions, we may experience a paradigm shift in the field." 

Eight years and multiple celebrity admissions later, are we there yet? Not entirely. While Dr. Motakef applauds high-profile patients like Marc Jacobs, Chrissy Teigen, and Sonja Morgan for helping to mainstream select plastic surgeries, he still sees "this culture of secrecy amongst some celebrities perpetuating the stigma." He alludes to J.Lo's olive oil controversy as a setback for transparency in plastics. 

But as much as we crave celebrity confessions, they sometimes serve as a reminder that a segment of society still criticizes plastic surgery and those who partake. This is particularly true when procedures go awry. Nothing exposes the latent stigma of plastic surgery quite like a bad result. "We see a ton of shame in aesthetic surgery patients who've had unexpectedly poor outcomes," says Dr. Levine. The overriding sentiment they receive is, "You chose this. You didn't need this facelift, but you went and got it." In Dr. Levine's experience, "there are few things more heartbreaking than this."

Regrettable results, however rare, exacerbate plastic surgery's PR problem. Whether it's filler or facelifts, "the bad results tend to scream," says Dr. Bayrak. They loudly reinforce the hackneyed imagery and notions we have burned in our brains. 

The Bullhorn of Social Media

"It’s going to take time to undo decades of secrecy and stigma," notes Dr. Bayrak. And no single celebrity can serve as a cure. Dr. Levine goes so far as to predict "there will always be a stigma associated with cosmetic surgery." Medical procedures are a private matter, after all. And there’s a fine line between privacy and secrecy and all it suggests.

Interestingly, Dr. Levine’s desire for privacy makes him a bit of an outlier in his field. Unlike many of his contemporaries, he doesn’t use social media to promote his practice or showcase his results. His patients appreciate the privacy this affords them. "They say to me every day, 'I love that you don’t do social media,'" he says. 

Be that as it may, there’s no denying that social media has elevated the conversation around plastic surgery—for better or worse. Our experts credit Instagram and YouTube with educating patients, demystifying procedures, and humanizing doctors—all of which help to erode stigma. But social media has a notorious dark side, too, particularly when it comes to matters of appearance and reality. The uncanny or unattainable extremes popularized by these platforms certainly aren’t a win for plastic surgery or its patients. "We’ve seen increased rates of body dysmorphia, self-esteem issues, and unrealistic expectations due to content on social media that misrepresents results or the way someone looks," says Dr. Soares. 

Signs of Progress

Still, plastic surgeons are encouraged by the hints of progress they see in practice. "I think we're evolving to understand the pursuit of cosmetic enhancements isn't an unhealthy choice, but a personal choice that can contribute to an improved self-image," Dr. Motakef says. As more folks are warming to this idea, stigma is gradually receding.

Even in more traditionally conservative areas, Dr. Nayak has seen an attitude adjustment of late. It's becoming more likely his patients will consent to having their photos published online and elsewhere. While facelift patients, in general, have always been the most resistant to this sort of sharing, even they seem to be coming around, he says.

In Dr. Nayak's opinion, the midlife facelift patient is largely responsible for normalizing cosmetic surgery. Having come of age alongside injectables, "they've been routinely improving themselves for the past 15 or 20 years," he says. They're in a pattern of fixing what they don't like, and many of these 45+ individuals see the facelift as a natural next step.

It helps that facelift techniques have been steadily improving too. It's now standard for surgeons to reposition the deeper layers of the face and neck and avoid stretching the skin. And most wouldn't dream of lifting in isolation, knowing facial harmony depends on a concert of tweaks—like fat grafting and laser resurfacing along with perhaps some finessing of the brow or eyelids. While it may seem counterintuitive, doing more usually creates a less-done look. 

As these results make their way into the world, Dr. Soares says, "people begin to realize the facelift doesn’t change who you look like but makes you look more like you, just with an added vitality.” In one study, when observers were shown a random sampling of headshots—not knowing some were taken before facelift surgery and others after (and never seeing a B&A of the same face)—they rated the women in the post-op pics as younger, more attractive, healthier, and more successful.

Another byproduct of good results is happy patients—and happy patients tend to be more open about their surgical experiences, says Dr. Somenek. This isn't a given, however; plenty of people are "ecstatic about their results, but don’t want to share them with the world," he notes. Regardless, a sort of domino effect seems to be occurring: Doctors do good work. Patients show it off. Perceptions start to evolve.

As the facelift becomes synonymous with subtlety, lDr. Motakef says, "it attracts a wider range of patients, and societal acceptance grows." And as the demographic continues to diversify, stereotypes crumble. According to Dr. Nayak, the most tuned-in plastic surgery patients see the facelift as more than just a restorative fix for older people—they consider it a tool of "self-perfection and self-expression."

The Bottom Line

While plastic surgeons aren't quite ready to pronounce stigma dead, they are confident transparency, in any form, is meaningful. Whether it presents as someone disclosing a facelift to the masses over social media or to their best friend over cocktails, that candid moment can help reframe plastic surgery as an act of self-care instead of an esoteric frivolity.

Ultimately, this is how we change the narrative. Facial plastic surgery is too often dismissed as "an unnecessary luxury," notes Dr. Bayrak. "We have to stop pretending caring about how we look makes us vain and superficial, and start accepting the really good psycho-social research we have showing that when we like how we look, we feel good about ourselves—and that transcends into other aspects of our lives."