Three hundred thousand dollars. That is what some New Yorkers are now paying for a facelift. Not a house. Not a college education. A facelift! In certain circles, a price that would have seemed absurd just a few years ago is now worn like a badge of honor.

The selling point is a "revolutionary" operation called the deep plane facelift, now a fixture of celebrity gossip and TikTok feeds. There is just one problem: it isn't new, and the evidence says it isn't better. Somebody needs to say so out loud.

I have been a board-certified plastic surgeon on Manhattan's Upper East Side for more than 30 years. The deep plane technique was introduced by plastic surgeon Dr. Sam Hamra in 1990, more than 35 years ago. We are told the eye-popping fees are justified because this more complicated operation gets better results. Our own medical literature says otherwise.

In a 1996 study published in Plastic and Reconstructive Surgery, surgeons performed a different facelift on each side of the same patient's face, comparing standard techniques with deeper, more aggressive ones. After a year, they found no differences. In a 2009 study in the same journal, four of the nation's most prominent facelift surgeons, Dr. Hamra himself among them, each operated on one of two pairs of identical twins using his own technique. Ten years later, all four patients looked better than before surgery, with only minor differences among them. A 2007 study of eight sets of identical twins reached the same conclusion: no technique produced a superior result. In 2024, Dr. Foad Nahai, editor emeritus of Aesthetic Surgery Journal, summed it up bluntly: "There is no evidence that one facelift procedure is better than another."What determines a good result is the surgeon's skill and judgment, not the name of the operation.

All of this reminds me of a bedtime story I once told my two sons. In Hans Christian Andersen's The Emperor's New Clothes, swindlers sell a vain king a suit of invisible cloth, and no one dares admit they can't see it, until a child shouts, "The emperor has no clothes!"

The surgeons are not con men; however, the public's reaction mirrors the fable. Patients line up to pay outrageous fees for a technique that is not new and delivers results comparable to well-established alternatives, and no one wants to be the one who admits they can't see the difference. Influencers, PR wizards, and social media make the illusion all the more convincing.

I believe in our capitalist system, and yes, cosmetic surgery is elective and paid out of pocket. No one is forced to buy a $300,000 face. But fees like these send an unhealthy message, both to the public and to our fellow physicians. Colleagues in other specialties remove cancers, prevent blindness, and transplant hearts, yet laws and insurers limit what they can charge to save lives, and thank God for that. When tightening a jawline commands more than saving a life, something is badly out of balance.

So what should a prospective patient look for instead of a price tag? Start with certification by the American Board of Plastic Surgery or American Board of Facial Plastic Surgery . Ask how many facelifts the surgeon performs each year and what their complication rate is. Insist on before-and-after photos of the surgeon's own patients, taken years after surgery, not weeks. And ask why a particular technique is right for your face, not whether it's the one trending online.

Bottom line: the most expensive surgeon performing the "newest," hottest technique is not necessarily the best option for you. More likely, the price reflects an elite and savvy social media presence. Some will call this sour grapes from a surgeon whose competitors earn far more for the same procedures. I wrote it because people deserve to know what the evidence shows. Listen, I am a native New Yorker. I get the need to flaunt it if you have it, and I understand the power of the Hermès Birkin bag. But don't be the unwitting emperor.

References

    1    Ivy, Lorenc & Aston, 1996, Plastic and Reconstructive Surgery. 21 patients each had a different technique on each side of the face, standard SMAS versus extended SMAS or composite (Hamra's deeper variant). No differences at one year.

    2    Alpert, Baker, Hamra, Owsley & Ramirez, 2009, Plastic and Reconstructive Surgery. "Identical Twin Face Lifts with Differing Techniques: A 10-Year Follow-Up." Hamra did a composite/deep plane lift on one twin. Only minor differences were found. It's a small study of four patients.

    3    Antell & Orseck, 2007, Plastic and Reconstructive Surgery 120(6):1667–73. Eight sets of identical twins; no technique gave a superior result.

    4    Nahai, 2024, Aesthetic Surgery Journal 44(10):1127, "There Is No Facelift for All Seasons." This is the source of the quote. He also calls "deep plane" a social media buzzword