The Pre-Menopause Facelift Is Having a Moment

Once upon an operating table, the only person you would likely catch choosing to undergo a facelift would be someone in their late 50s, 60s, or even older, displaying evident signs of aging. Fast-forward to 2025. If it seems like more women are opting for fancy facelifts before the throes of menopause hit hard, it’s because they are. Today, the perimenopause facelifts are just as popular as those performed on more mature women experiencing significant declines in estrogen, and some plastic surgeons believe this early approach is the key to long-lasting, natural results.

Why Is Everyone Getting a Facelift Early On?

Perimenopause, which typically begins in a woman’s 40s and early 50s, is a time when estrogen levels begin to decline, resulting in changes to the skin and facial structure. “Facial aging along the jawline, neck and midface becomes more evident,” says La Jolla, CA plastic surgeon Robert Singer, MD. And, in today’s world of social media, people are more critical of their faces than ever. “Younger facelift patients don’t tolerate getting old. So, while their mothers may have had a facelift in their 60s or 70s, for example, the perimenopause facelift patient wants to look as good as possible without major rejuvenation.

Palo Alto, CA, facial plastic surgeon Jill Hessler, MD is seeing an upward trend toward earlier facelifts for women. “Previously, patients looked to injectables, thread lifts, radio frequency and other facial treatments to avoid going under the knife for as long as possible. Now, thanks to newer techniques, the results of surgery give a refreshed and rejuvenated—but not windswept or different—look.”

So who is a good candidate? Palo Alto, CA facial plastic surgeon David Lieberman, MD sees patients in their 30s and 40s who are concerned with skin laxity and a loss of definition, which he attributes to several factors. “Rather than waiting for significant sagging or jowling to occur, many women are addressing early signs of aging proactively.”

While the effects of aging during perimenopause may not be as apparent as they are later in life, a facelift at this stage is less about a complete overhaul and more about subtly improving facial contours. While many people in their mid-to-late 40s dabble with injectables, fillers, energy-based devices and other treatments, New York facial plastic surgeon Edward S. Kwak, MD says these options typically offer temporary or subtle improvement at best. “They cannot adequately address skin sagging and structural descent, so for those seeking a more definitive, longer-lasting correction, a facelift is the only approach that delivers that result.”

This 53-year-old patient had a facelift and necklift with New York facial plastic surgeon Konstantin Vasyukevich, MD to refine and lift the lower face.

Hormones + Facial Aging

One of the primary reasons why patients opt for a facelift during perimenopause is because they have healthier levels of collagen and elastin, which estrogen influences. According to Dr. Kwak, retaining collagen and elastin in the skin, as well as healthy muscle tone, makes the skin, soft tissue and underlying musculature more predictably responsive to surgery. “There’s also less fat loss during perimenopause, so the triangle of youth—fullness in the midface and a pronounced narrowing of the chin—remains largely intact,” he explains.

As the youthful highlights and contours slowly give way to what Nashville, TN plastic surgeon Dan Hatef, MD calls the “shadows of age” due to hormonal changes in a woman’s 40s, subtle facial transformation begins to set in. “Patients are becoming savvier about the abilities of surgery to restore a youthful look to the face,” he says. In addition to hormonal fluctuations, lifestyle factors also impact facial aging. Dr. Singer adds that smoking, excessive exercise, sun exposure, metabolic changes, and poor diet can all impact one’s facial appearance.

The Benefits of a Perimenopause Facelift

Perimenopause and menopause are natural, expected life phenomena, and their effect on facial aging can be improved with the right approach. “While there’s no one universal treatment, if there is significant skin laxity, surgery is the only option,” Dr. Singer says.

Facelift procedures rose by 1 percent in 2024, with more Gen X and millennial patients opting for surgery to stay ahead of visible signs of aging

Source: American Society of Plastic Surgeons

With the skin being somewhat younger during perimenopause, recovery is almost always easier. That’s because younger skin heals more efficiently with fewer risks and better scarring. Dr. Hessler notices that women who undergo a facelift before menopause tend to recover more quickly, and their skin bounces back more rapidly. “Their hormone levels allow for collagen and elastin regeneration as needed to heal the manipulated tissues.”

Dr. Hatef adds that most women who opt for a facelift in their 40s typically have less fat atrophy, making volume loss less of an issue. “Any fat grafting we’re doing is more targeted, smaller volume, and done for skin rejuvenation rather than facial shape.”

The Results

While the idea of a facelift before menopause may sound off-putting to some, Dr. Kwak points out that the results are typically more natural-looking and longer-lasting in younger patients compared to those with more advanced signs of aging. However, getting a facelift before menopause doesn’t guarantee you won’t need a future touch-up. “Future signs of aging are often more subtle, and any revision work is often less extensive,” Dr. Kwak says. “A facelift during this transitional period can help maintain confidence, presence and alignment between appearance and vitality.”

Miami plastic surgeon Paul Afrooz, MD performed a browlift, facelift, necklift and fat transfer on this 45-year-old patient.

Can Menopause Undo the Results of an Early Facelift?

If you’re worried that having a facelift during perimenopause will render your results good for nothing once menopause hits, Dr. Hessler says that’s not the case. “Menopause will not undo a well-executed facelift.” While the skin will relax over time and menopause can accelerate skin-related changes, following a good skin-care routine to maintain collagen will help preserve the results. “It’s important to pay attention to soft tissue and bony volume loss that can occur during and after menopause,” Dr. Lieberman adds. “Sometimes, replenishing volume or doing a skin-resurfacing treatment can be a nice secondary procedure several years after a facelift.”