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Key points
- Cosmetic surgery is driven by a variety of motivations, such as the desire to be more attractive, confident, and make new friends.
- More than half of people experience symptoms of anxiety or depression in the days following a facelift, research suggests.
- Mental health benefits often appear after a longer time, including greater well-being and life satisfaction.
Body image is a complicated concept, as it encompasses perceptions, thoughts and feelings about the body over time. As people age, the focus on body features tends to shift predominantly onto facial attractiveness including the skin, eyes, cheekbones and jawline. It follows that facelift procedures are some of the most common aesthetic surgical procedures undertaken by those over 40 years of age.
While the primary goal of facelift surgery is to create an outward appearance that reflects the patient's inner spirit and sense of beauty, studies have not shown any relationship between the degree of facial aging and the amount of patients’ concern. Furthermore, there is no documented association between the amount of objective improvement after facelift surgery and patient satisfaction. To fully understand the impact of facelift procedures on mental health, we need to examine patients’ underlying motivations for surgery, the immediate postoperative effects, and longer term quality of life measures.
The motivations behind facelifts vary significantly from person to person, and the true motivation may even remain subconscious. Historically, previous authors have tried categorizing motivations based on age classifications. For example, individuals aged 40-50 have been coined the “worker group.” These individuals are typically motivated by the effect that their more youthful/attractive appearance would have on their careers. The group of individuals over 50 have been called the “grief group” or the “renewal group” as a significant portion of these individuals (up to two-thirds) are grieving over the death or loss of a loved one and seeking a means to help gain self-confidence, self-esteem and a chance to make new friends.
A different way to conceptualize motivations solely focuses on post-operative goals with less emphasis on patient age. These have mainly fallen into three groups: (1) desire to feel physically younger, (2) improving one’s marriage or attracting a new partner and (3) miscellaneous (work-related, vanity etc). The underlying reason one chooses to proceed with facelift has an important role in their immediate postoperative psychological reaction.
One clinical study identified at least some degree of psychological disturbance in 54% of patients after undergoing a facelift. Most commonly, patients expressed depression or anxiety within the first five days after surgery, which typically disappeared by the end of the first week. The authors of this study concluded that these short-term depressive episodes were associated with self-consciousness about the potential social stigma associated with having undergone cosmetic surgery.
In this study, there was another group of patients that became depressed during the weeks after the operation and remained depressed for up to six months after the operation. The only significant identifying characteristics in these patients were an increased prevalence of neuroses (as identified through preoperative personality assessments) and a lack of self-described social/emotional support systems.
Despite these negative short and medium-term impacts on emotional health, several studies have shown long-term mental health benefits for those undergoing facelift procedures. Multiple studies report an improved sense of well-being and overall life satisfaction when measured more than a year after surgery. However, it should be noted that patients with pre-existing depression were less likely to experience these positive psychological improvements.
Patients undergoing cosmetic surgery have emotional and social concerns that pertain to facial appearance more so than the general population. The decision to pursue a facelift is not minor—there are complex motivations and significant physical and emotional risks along with monetary costs. One of the most common risks is that of short- to medium-term depression in the recovery period. However, the long-term impacts on self-confidence are more favorable for the facelift population on the whole.
Given the understandable impact on emotional health and well-being that a facelift can have, it is critical for patients and clinicians to honestly and thoroughly discuss any mental health concerns prior to going under the knife.
