Facelifts are increasingly offered to younger patients in their 30s and 40s as a “preventative” option. I have strong opinions about this trend, because a traditional facelift is often the wrong tool for what’s happening to your face at this stage, and I think it’s worth explaining why.
Two different problems, at two different points in the timeline
A traditional facelift is designed to address significant skin laxity and descent — the kind of change that tends to be more pronounced in the postmenopausal years, roughly 55 to 65, when the cumulative effects of prolonged estrogen decline have had more time to reshape both bone and soft tissue. It’s a powerful, appropriate procedure for that stage. It’s also more invasive, with longer incisions, longer recovery, and more scarring than most perimenopausal patients need or want for what they’re actually dealing with.
Perimenopausal patients are usually facing something different: early volume loss, mild-to-moderate brow and midface descent, and the first structural effects of bone resorption — but not yet the degree of skin excess that a traditional facelift is built to correct. Reaching for the same tool at both stages, in my opinion, is a mismatch. It’s why I think of a facelift as something to grow into, not something to start with.
Why endoscopic surgery fits this stage better
Endoscopic brow and midface lifts are performed through small, well-hidden incisions, typically within the hairline, using a camera to work under the skin without the longer incisions a traditional lift requires. For the right candidate, that translates into real, practical advantages: significantly less scarring, a notably faster recovery, and less disruption to the surrounding tissue — all of which matter more, not less, to a patient who is still working, still active, and not looking to disappear for weeks of downtime.
It’s also, frankly, a better match for what’s structurally happening at this stage. Early brow and midface descent responds well to repositioning and fixation — you don’t yet need the more extensive tissue removal and repositioning a traditional lift performs, because the underlying tissue hasn’t yet lost that degree of integrity.
How the lift is actually achieved: Endotines
The fixation in an endoscopic lift is typically achieved with devices like Endotine or Endotine Ribbon implants — small, absorbable devices that anchor and hold repositioned tissue in place while it heals into its new position, then gradually dissolve over several months as your own tissue establishes lasting support. This is part of what allows the procedure to be less invasive than a traditional lift: instead of removing and re-draping large amounts of tissue, the goal is to reposition what’s there and let it heal into place, with less trauma to the surrounding tissue of your face than, say, a deep-plane facelift.
Combining brow and midface for a natural, lifted result
I often perform an endoscopic brow lift concurrently with a midface lift, rather than treating them as separate procedures. The brow and midface are structurally connected, and lifting one without the other can create an imbalanced result — a rested upper face paired with a midface that still looks tired, or vice versa. Addressing both together restores a more naturally lifted, refreshed contour through the upper and mid face — the kind of subtle, all-over lift that reads as rested rather than “done,” without pulling the face into an unnatural shape.
And if you’d rather not have surgery at all
Surgery isn’t the only meaningful option at this stage, and I want to be clear about that. For patients who aren’t ready for, or simply don’t want, a surgical procedure, nonsurgical energy-based devices and biostimulatory injectables like Sculptra can produce genuinely meaningful improvement in early brow and midface descent. These won’t achieve the same degree or duration of correction as an endoscopic lift, but for the right patient and the right degree of change, they’re a legitimate, less invasive way to address early structural loss rather than an inferior consolation option.
Who this is, and isn’t, right for
This isn’t the right procedure for everyone, and it isn’t a substitute for a traditional facelift once skin excess becomes significant — at that point, endoscopic techniques truly can’t achieve what’s needed, and recommending them anyway would be doing a patient a disservice. But for the right perimenopausal patient — someone with early brow and midface descent, good skin quality, and a desire for meaningful improvement without an extensive recovery — I think it’s very often the more appropriate, proportionate choice.
My general framework: nonsurgical options for patients with early change who want to avoid surgery altogether, endoscopic techniques for perimenopausal patients ready to address early structural change surgically, and traditional facelift reserved for postmenopausal patients whose skin and tissue changes have progressed further. Matching the approach to the actual stage of change, rather than defaulting to the most well-known option, is a big part of what I think good judgment in this field looks like.
This is part of an ongoing series on evidence-based, stage-appropriate options for women navigating perimenopause and menopause. If you’re wondering what’s actually appropriate for where you are right now
