It looks as though you would certainly benefit from a facelift with tightening of your neck. Prior to any surgery, it appears that you should do your best to establish your ideal weight ( ideal weight in my mind- is the best that you can do - not some ideal weight in a book). Once your weight is in an ideal range, you can begin to focus on the surgical apsects.
Jowling develops when the cheek skin and fat loosen and sag downward with age. This collects just behind the fold between the nose, the corner of the mouth, and the side of the chin at the jawline. As your photo shows a squarish shape to your lower face due to accumulation of fat in the lower jowl at the jawline, along with deepening of the so-called marionette fold, I think that you would need at least a lower facelift or short scar facelift to lift up the sagging fat in your lower face. This would recreate a more youthful heart-shaped look, smooth out the jowl and the marionette fold, and leave you with a smoother jawline. Also, some strategically placed stitches under the skin near the front of the cheek can nicely lift up the corner of mouth, therebye creating a more pleasing look. This surgery could be performed either in an office or other outpatient surgery suite under local anesthesia and IV sedation. The cost would vary in different parts of the country but would be less than a complete facelift.
Everyone ages at a different rate. Some
patients at 38 have more aging than those much older. It depends on numerous
factors including: heredity, history of smoking, lifestyle, sun exposure,
excessive exercising, underlying medical health, and significant weight loss.
In the past, it was felt that 38 would be
too young to have a facelift. Now most experienced artistic plastic surgeons
would feel differently. It really depends more on the extent of aging, your desired result and the
individualized approach that is necessary to achieve a natural appearing
A face including neck contouring would appear to be the most appropriate procedure. Buccal fat pad removal will not achieve a good cosmetic improvement.
Keep in mind that following the advice
from a surgeon on this or any other website who proposes to tell you exactly
what to do without examining you, physically feeling the tissue, assessing your
desired outcome, taking a full medical history, and discussing the pros and
cons of each operative procedure would not be in your best interest. I would
suggest you find a plastic surgeon certified by the American Board of Plastic
Surgery and ideally a member of the American Society for Aesthetic Plastic
Surgery (ASAPS) that you trust and are comfortable with. You should discuss
your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
It does appear that your face is heavy in the jowl area. I believe the best bet for your money would be to have some type of facelift with liposculpting. This would give you a softer, more youthful look!
An examination of you would be needed to give you the best advice, but it does appear from your photo that you would be a good candidate for a facelift and liposuction under your chin. These procedures should address the issues with your face. Costs are going to vary by surgeon.
I think that a lower facelift with liposuction of your neck would be worthwhile considering in your particular case. Although you are only 38 years of age, I have performed the occasional lift in patients your age who were quite pleased with their results.
A conservative facelift could correct the problem of your jowls and sagging cheeks. There is no magic age for facelift surgery. It can be performed when needed. Consult with a Board Certified Plastic Surgeon for an exam, to discuss your options and expectations.
Buccal fat removal is not the right option for you. From the one photo you provide, I would offer you a facelift, submental liposuction and liposculpture. Costs vary between surgeons and facilities. It should also be low down on your list of questions. More important to find a surgeon with a lot of experience in contemporary facelifting who will happily show you results and introduce you to former and current patients.
A full facelift with liposuction is what you need to remove the excess fat and skin. The cost can be determined after a face to face consultation. Face forward and profile photos are preferred.