Last in a seriesLast year, at age 64, she had a face-lift. Her first. “It was pretty rugged, but I absolutely will do it again.“I’m fighting aging tooth and nail,” she said.When her chin line started sagging, she couldn’t stand it. “You work very hard all your life not to let yourself get heavy and not to abuse your skin, so you’re kind of OK from the neck down. But things happen to your face. That’s where you show the age first.”The most surprising part of the surgery, she said, was the reaction of close friends. “They were horrified by it, and that floored me.”Before she signed up for surgery, Anne (not her real name) talked to lots of women. She heard all the trite lines about earned wrinkles and aging gracefully. “I got so much grief from people. They would reach up and grab the skin around their neck and say, ‘Look at this! It doesn’t bother me.’ That was supposed to discourage me.“It’s a very personal thing,” she said. “The way I look at it, if it doesn’t bother them, then that’s their choice.”She figures many of them have spent enough over the years on lotions, makeup and skin creams to pay for her $5,000 face-lift. “I never spent money on makeup or skin creams, not ever. Women I know who spend incredible amounts of money on creams and makeup see that as an entirely different thing.“I don’t understand why it’s OK to cover up something you don’t think looks good, but somehow it’s not OK to let a surgeon change it. Is there some moral difference? I would put the cost of that procedure up against their makeup and lotion bills any day.”Because of the pain involved during recovery, it’s important to have understanding, nonjudgmental people around, she said. “I don’t know how anybody could do it alone.”The procedure took about three hours. “I didn’t hurt,” she said. “All I felt was tugging.” She emerged with two sets of stitches.Last year, 128,667 people in America had rhytidectomies, the official name for face-lifts. The figure has dropped 12 percent since 2000, probably because of a surge in nonsurgical techniques such as dermabrasion and laser treatments. But face-lifts still rank among the top five plastic surgery procedures.Nothing beats a face-lift, said Dr. Ted Jackson, a Charleston plastic surgeon. “More people are willing to consider lesser procedures, but you don’t get something for nothing. A lesser procedure is going to give a lesser result. You can never truly replace surgery.”The total cost, according to national figures, ranges from $6,000 to $12,000, with an average of $8,500. In a spot check of Charleston surgeons, charges ranged from $3,500 to $8,000. Like a lot of other things, price depends on the work involved. “If someone’s skinny and a good candidate, the operation is easier,” Jackson said. “If it’s more difficult, it will cost more.”And, the procedure likely will cost more in large metropolitan areas. “Guys in Manhattan charge $35,000 for face-lifts, and they have a waiting list,” Jackson said.Because a face-lift won’t improve the forehead, eyelids, brow or wrinkles around the mouth, many patients opt for additional procedures while undergoing the face-lift. That obviously increases the cost.Most face-lifts are performed on patients from age 40 to 60, but age apparently isn’t a problem.“I’ve done face-lifts on patients in their 70s,” Jackson said. “There is no certain age. It’s just when you can obtain an improvement that will make you happier.”“People are having the surgery when they’re younger and it’s less drastic,” said Charleston plastic surgeon Andy Stewart. “The big swing is to maintain a youthful appearance and avoid the full overhaul.”“I have a girlfriend whose mother is in her 90s, and she’s thinking of having one,” Anne said, “and I think that’s wonderful.”Refinements have erased much of the brutality associated with face-lifts, doctors say.“It’s easier now,” said Anne’s surgeon, Dr. Augusto Portillo. “We’ve cut down on the amount of cutting.”For forehead-lifts and partial face-lifts, he said, surgeons often use endoscopic techniques involving the use of a tiny magnifying camera on a probe. The camera allows surgeons to see under the skin through minuscule incisions.“A face-lift is not like it used to be,” Portillo said. “You can cut corners and get the same result with less cutting. A patient may come to me thinking they have to have a face-lift. Just doing the eyelids and nose and drooping brows may be more beneficial. With experience, you learn to make shortcuts.”Incisions for a traditional face-lift start inside the hairline at the temples, extend downward in front of the ears, then move behind the earlobes and into the lower scalp.The surgeon separates skin from the fat and muscle beneath, then actually lifts the skin off the face to tighten and reposition the underlying tissue, sometimes trimming or suctioning fat. The skin then is redraped over the face and pulled up and back. The surgeon trims any excess skin and stitches the skin in place.“Face-lifts are evolving,” Jackson said.“The technique is a lot more elegant than what I was taught 15 years ago, and the effect is softer and more durable.”The old way involved simply stretching the skin tight and sewing it back up, he said. “The new technique is more demanding because it involves repositioning sagging fat and muscle. You have to go two layers below the skin to the muscles and connect tissues that animate the face and lift them back up.“It’s like repaving a road,” he said. “You can pave over top of it, but if you don’t fix the slip under it, you’ll never get it right.”Anne allowed a week to 10 days to recover.“I tried to hibernate, but you can’t get away from people,” she said. “I don’t think that part is as bad as it used to be, because more people are having cosmetic surgery.“I came back from one appointment and thought I could make it into the house. But the two guys across the street were getting out of their car. They said, ‘Did you do what we think you did?’ I told them to cool it. And they said, ‘You go, girl!’”During her recovery, she had to sleep with her head elevated, and she consumed liquids because she wasn’t allowed to chomp. She couldn’t wash her hair. “It did hurt afterwards,” she said, “but I was more fearful about damaging the work they’d done.”The surgeon told her it could take a year to appreciate the full effects, but she felt good about the way she looked in about a month. “It’s not like in the movies, where they take the bandages off and there you are. There’s no big unveiling. It’s a gradual thing.”And subtle. “It looks more like I got a good night’s sleep,” she said.“Some people who haven’t seen me in a while would tell me that retirement must be agreeing with me.”She isn’t worried about the lift falling, she said. “That’s not what happens. Once the face is tightened, the normal aging process continues. The lift just sets it back.”Experts say a face-lift generally turns back the clock seven to 10 years.While the clock doesn’t stop ticking, according to a Mayo Clinic newsletter on the subject, “You can assume that 10 years down the road, you’ll likely look better than if you hadn’t had a face-lift.”The procedure might improve saggy, wrinkled skin, the newsletter notes, but it probably won’t affect other age-related changes. “Results vary considerably, and healing can be lengthy and uncomfortable.”Although pleased with the final results, one face-lift patient said the downsides of the operation shocked her.“I didn’t think anything would be that painful,” she said. “It was worse than when I had my breasts done. I stayed numb for more than a year. Even now, there’s a weird sensation when I touch around my ears. And I lost hair around the sides of my ears, so there are triangular bald patches, and I can’t wear my hair just any way.”“And so,” the Mayo Clinic newsletter asks, “is it worth doing? Only you can decide.”To read this series in its entirety, visit www.sundaygazettemail.com or www.wvgazette.com.To contact staff writer Sandy Wells, use e-mail or call 348-5173.