Typically, skin laxity starts to become noticeable in one's early forties. Many women are having facelifts in their mid-forties. Patients that I see in their early fifties often tell me, "You know, I was doing alright up until just last year. Then my face just seemed to fall apart." Sometimes they may make a correlation with menopause or a stressful life event such as a divorce or loss of a parent.

The chronological age is really not important. What is important are the findings themselves - loose skin, sagging cheeks, jowls. When these are present and troubling to the patient, a facelift may be recommended whether she is 45 or 55. I have patients in my practice who were ready for a facelift at 42 (Patient C.C. in Photographs). Others may wait until their fifties before their skin tone has loosened enough to have a facelift. There are very few genetically-advantaged patients who would not benefit from a facelift by their mid-fifties. It amuses plastic surgeons to see actresses who say they have no interest in cosmetic surgery in their forties; invariably they come to another conclusion one morning while looking in the mirror in their fifties. Mothers say to their disapproving daughters, "Just you wait."

Genetics are most important. If you want a glimpse at your future appearance, just take a look at your parents or other close relatives.

Sun exposure matters particularly in lighter-skinned patients with less ultraviolet protection from melanin who are therefore more susceptible to photo-aging. Fortunately this effect is avoidable with diligent use of sunscreen and hats. In fact, the skin will improve with sun protection, even in middle age. Patients should not feel that the damage has already been done and there is little point in changing their habits.

Ethnicity and gender make a difference. Fairer skin types tend to wrinkle and sag more than darker skin types. Thin skin ages faster than thicker skin, and this is why females tend to come in at an earlier age than men. In my practice, Caucasians present for facelifts earlier and more commonly than Asians, Hispanics, African Americans and other patients of color.

Does Smoking Matter?

Conventional wisdom holds that the mechanics of tightening your lips around a cigarette causes more lines around the lips commonly known as smoker's lines. But we see these in plenty of non-smokers too. Of course, smoking cannot be good for the skin, but whether it affects skin aging is unknown. One thing is certain - smoking interferes with skin circulation and is to be avoided around the time of surgery because it increases the risk of healing problems.