Let’s Talk About Mental Health and Facelifts

Nora Ephron famously felt bad about her neck, but Kris Jenner loves her facelift so much that she’s selling merch to celebrate it: a white T-shirt and matching baseball cap reading “I’ll Have What Kris Jenner Is Having.” In a 2003 essay first published in Vogue, Ephron—who died in 2012—mused about the potential risks and rewards of getting a face and neck lift, a somewhat stigmatized subject at the time. Now, 22 years later, more and more public figures are opening up about having facelifts (Sonja Morgan, Marc Jacobs, and Sia join Jenner in what’s being called plastic surgery transparency). Curiosity about facelifts is spiking; just take a look at the Google Trends chart for the term over the past 12 months.

Many of the celebrities who talk about their facelifts choose to do so because, like Jenner, they’re thrilled with their results. But if you take a peek at anonymous forums like Reddit’s r/PlasticSurgery, you’ll see a more complex set of experiences. It’s true that many are very happy with their results and experience a significant rise in self-confidence after the procedure—but others are disappointed with the results; struggle with depression or anxiety while recovering in isolation; or simply feel that they no longer look like themselves.

The conversation about mental health and plastic surgery is a nuanced and necessary one—and a good plastic surgeon should keep mental health in mind throughout the process, from the initial consultation to recovery. “There’s a lot of intersection between the mental health effects of facelifts and body image, aging, identity, and self-esteem in general,” says Kiana Shelton, LCSW, of Mindpath Health in Texas. “Whenever we’re thinking about making any type of change to our physical appearance, exploring the why can be really helpful.”

First comes the initial consultation, which the American Society of Plastic Surgeons (ASPS) notes should include a thorough mental and physical health history. Surgeons should be on the lookout for warning signs of body dysmorphic disorder (BDD)—a mental health condition in which people can’t stop thinking about perceived defects or flaws in their appearance—as well as other pre-existing psychological conditions, a support system, or unrealistic expectations about what a change in their appearance will accomplish. However, some studies suggest that many plastic surgeons aren’t very good at recognizing BDD—in one 2016 survey, 84% of plastic surgeons said that they had unknowingly operated on patients with BDD.

Dr. Raghu Athré, a facial plastic surgeon based in Texas, estimates that he turns away prospective patients around 10% of the time because they’re not in the right place mentally or emotionally. “I’ll say, ‘Hey, listen. I don’t think that a facelift is probably the appropriate procedure for you at this time, and we can probably talk about this in the future.’ And I’d say probably of those patients, about 50% come back later and go, ‘You know what? You’re right. That was probably a bad time for me to do that,’” he says. “When you have that level of honesty, you’re able to kind of really pick the patients that you want to do and you get great results.”

In the consultation stage, honesty is vital, Dr. Athré adds. “If they come in and show you an Instagram picture, saying, ‘I want this,’ it is the surgeon’s moral and ethical responsibility to go, ‘Listen, first of all, that ain’t going to happen, okay?’ Or, ‘That’s a fad,’” he says. “We have to learn to address this and not work for just the concept of getting a paycheck.”

Then comes the procedure itself, and after that, the initial post-op period, which typically lasts around two weeks. Even patients who are overjoyed with the final result sometimes struggle with depression or anxiety in the initial days after surgery, due to pain, discomfort, isolation, and difficulty sleeping. Plastic surgeons say they can help alleviate this risk by preparing patients for what the post-op period will realistically look like, both physically and emotionally.

“I tell my patients you will be depressed on post-op day three to four, end of story,” says Dr. Athré. “You need to prep for this.”

Dr. Michelle Lee, founder of PERK Plastic Surgery in California, advises patients to make sure they either have a loved one to stay with or hire a private nurse during the recovery process, but aren’t alone. “Nobody should be going through a procedure like this completely by themselves,” she says. “It’s like anything in life. You want a community to go through this with you. You don’t have to broadcast it on social media, but you should have a trusted friend to support you.” She also tells patients to avoid mirrors for the first few days, when bruising is at its worst, and to get out of the house and into nature—“with a big hat on, of course.”

Dr. Yael Halaas, a facial plastic surgeon based in New York, has her patients get Exomind, an in-office mental wellness treatment that uses transcranial magnetic stimulation (TMS) to target specific brain regions. “This is something they can do during that initial [post-op] period of time that will help them mentally,” she says.

Patients who already have a therapist may find it helpful to schedule a virtual session or two in the first few days of post-op, suggests Noelani Sagapolutele, LCSW, co-founder of the Hawai’i-based Wa’a Collective. “It could be good to have somebody check in virtually because we can have our cameras off, but the patient can still stay connected to someone,” she says.

With proper preparation on what to expect, many patients find that the initial post-op period isn’t so bad. Judy, who treated herself to a facelift for her 60th birthday, says she felt a “little stir-crazy” during the first week, but otherwise, it was fine. “I just maintained a positive attitude throughout the experience,” she says. “I rested and, as the doctor ordered, took the medications and the antibiotics.” For her, it was totally worth it; she’s “thrilled” with the results. “I really wanted to feel as young on the outside as I did on the inside,” she says—and now she does.

The initial post-op recovery period also brings the risk of opioid addiction for some patients, as is the case any time opioids are prescribed for pain management following any kind of surgery. Although the ASPS has guidelines on prescribing opioids, a 2021 study titled "Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic?" found that the answer to that question is no—or as the study puts it, “there is an unmet need for practical and comprehensive training regarding safe opioid prescribing among plastic surgery trainees.”

However, each surgeon I interviewed explained how they helped patients manage the risk of addiction. These methods include screening for a history of addiction, checking a patient’s recent prescription history (required by law in New York), bringing in a pain management specialist if appropriate, prioritizing numbing and non-narcotic medication, and avoiding certain opioids, such as oxycodone. Another method is refining surgical and anesthetic techniques so that patients are less likely to need heavy-duty painkillers. “With good technique overall, patients are actually comfortable after a facelift,” says Dr. Halaas. “They’ll report feeling tight, but not feeling pain.”

Then there’s the perception that plastic surgery itself is addictive—that getting a facelift is a slippery slope—one that leads to a desire for rhinoplasty, blepharoplasty, liposuction, etc. Plastic surgery addiction is not included in the DSM-5, unlike alcohol dependence and substance use disorder. However, body dysmorphic disorder is included, and scientific discussions of plastic surgery addiction tend to characterize it as a symptom or result of BDD.

The surgeons I spoke to about the potential of plastic surgery addiction had a nuanced view of the idea—sometimes “attention drift,” as Dr. Halaas calls it, does happen: “It’s like maintenance for your house: My bathroom is terrible, so I need to replace it. Then you’re like, My kitchen could really look better, too. I painted the front of the house, but the landscaping is looking a little shabby.” Dr. Lee uses another analogy: “Just because you do a facelift doesn’t mean that you’re good to go for the rest of your life. It’s sort of like saying, I want to be healthy and fit, but I’m only going to run one marathon and that’s it. Is going to the gym addictive? I don’t think so. But it has to be in proportion.”

And again, it’s all very individual. Judy chose her surgeon—Dr. Lee—because she wanted a natural look, and two years after her surgery, her priorities haven’t changed. She’s done some injectables, including Daxxify and Botox, but no additional surgeries. “I never want to overdo anything,” she says. “I’m just not that type of person.”

Once the initial facial swelling and bruising have lessened, patients can see the results. While many patients are happy with their appearance after a facelift, some are not—either because they had unrealistic expectations or something went wrong, leading to a “botched” appearance. However, the regret rate is relatively small compared to other cosmetic plastic surgeries: a 2024 study of 2,153 facelift patient reviews found that 92.24% were positive and 7.76% were negative. Although rare, this risk is still worth considering because of the profound mental health effects it can have. Sagapolutele says being unhappy with the results could even lead to “psychological harm.”

Elizabeth Kanna, a brand and AI manager, has had two facial procedures—one she was happy with and one less so. First, she had a lower face and neck lift in 2017. Initially, she was mostly satisfied with the results, but she was left with some minor scarring on the side of her face that she disliked, and the results of the neck lift didn’t last as long as she had expected. She was also unhappy with the doctor’s bedside manner; she says that he rushed the procedure and had a trainee conduct much of the surgery. “I felt like I paid for the surgeon, but I ended up getting his junior person,” she says. “Would I do it again? With a different surgeon.”

Then, in 2024, she had a Full Face Resurfacing procedure (involving a blepharoplasty and facial laser resurfacing) with a friend of hers, Dr. Adam Scheiner, a facial cosmetic surgeon based in California. She had a significantly better experience throughout the process. “There was more emotional support, and a lot of support about the expectations of recovery,” she says. And she was thrilled with the results. “I feel like I have my 30-year-old eyes. My daughter keeps calling me ‘Doe Eyes,’” she says. “Every time I wash my face or put on makeup, I feel like my skin’s so healthy.”

Then, there’s the social stigma to deal with. In some communities, getting a facelift can lead to social stigma because it’s perceived as vain, “fake,” or a waste of money. “Maybe in Hollywood it’s super accepted, but in some realms such as church or government, it could be viewed as, What in the world did you just do?” says Sagapolutele. “Social fallout could happen because of something that you thought was going to be so great.”

But on the other hand, there’s a potential social benefit, too. When you look younger, people treat you better, and when you look more attractive, people are more likely to hire you and pay you more. After all, we live in a society in which youth and beauty are highly valued, so getting a facelift can be a business decision as well as a personal one. “There’s sometimes a professional or social standard” that a person feels they need to meet, Shelton says. “We are an appearance-conscious society. No matter how large or small your influence is, whether it’s just your smaller circle or you’re in the public eye, being appearance-conscious is woven into the fabric of our culture. And it is something that everybody is thinking about.”

Some of these factors might make facelifts sound like a huge risk to mental health—but for some patients, a facelift can be life-changing, bringing a significant improvement in self-confidence that leads to a fuller social life, career momentum, and even a new romance. “We see it all the time: People have a restored sense of confidence. They tend to be more active and more social. They feel that their outside is reflecting their inner vitality,” says Dr. Halaas. “It’s such a gratification to have the patients be happy and feeling more joyful.” Shelton says that this increase in confidence can have an impact on mental health, too: “It can create less social anxiety or fewer depressive symptoms, especially if their appearance was a trigger for them in terms of their distress.”

The emotional changes can sometimes be so strong that they feel like physical changes. Dr. Athré recounts one facelift patient, “She said, I feel so much more energetic. You didn’t fix my thyroid gland, but now, I want to do stuff. I want to go out for dinner with my husband. I feel attractive again.”

Judy says she’s very happy with the way she looks post-facelift: “My daughters both say that I look like I did when they were young, so that gave me a good feeling because I had such natural results,” she says. She adds that her facelift has led to an improvement in her physical health, too. “It gave me more motivation to work out again. Before, especially during COVID, I got lazy, and I wasn’t working out as much. But when you feel like your face looks so good, you want the body to go with it. So I got into working out, I got into hot yoga, I took tennis lessons, I was just really getting into the physical health aspect of it. Eating healthy again, too.”

For her part, Nora Ephron chose not to get a facelift because she didn’t want to risk unwanted changes. “I would rather squint at this sorry face and neck of mine in the mirror than confront a stranger who looks suspiciously like a drum pad,” she wrote. However, she concluded her essay with an acknowledgment that the physical signs of aging still bothered her: “Of course it’s true that now I’m older, I’m wise and sage and mellow. And it’s also true that I honestly do understand just what matters in life. But guess what? It’s my neck.”