My skin and facial muscles have started to sag. I don't really have wrinkles, but I do have sever Marionette lines. My cheeks are sunken and my eyes look hollow. I've heard and talked to doctors about several lasers and fillers, but realized that at the end the tab would cost as much as a facelift, considering that I'd have to go back every year for more fillers and more laser treatments. They say though, that I'm too young for a Facelift. Any advice?
Is 40 Too Young for a Facelift?
Doctor Answers 87
Many 40-year old patients benefit from skillful facelifts
20 years ago, this question would not have come up. It would have been considered inappropriate by most surgeons for a 40-year old to consider a facelift except perhaps in acne patients with skin laxity.
Now, especially for patients in the entertainment industry who make their living on air, it is more common than not that they undergo cosmetic surgery, including facelifting procedures.
20 years ago the typical facelift patient would have had been offered a facelift with high lateral pull causing loss of the sideburn and a Nike swoop effect due to uncompensated sagging of the midface, a coronal browlift causing significant elevation of the frontal hairline, and hyperelevation of the central brow causing a quizzical appearance. The significant and widespread resultant loss of hair could immediately create the appearance of age rather than youth. The mantra was often the tighter the better.
Facelift techniques have evolved. Accomplished facelift surgeons can now routinely perform gentle facelifts with preservation of all anatomic features. It is possible to preserve the sideburn, the tragus (bump in front of the ear), earlobe shape and cant, and posterior hairline, and to bury the scars so they are minimally apparent.
These advancements do not occur by accident, they occur in the planning stage before the first cut is ever made. It is determined before the surgery starts how your outcome will be.
There are many ancillary procedures and techniques that were not available such as volume restoration with fat or LiveFill (nontraumatized fascial fat grafts); cheek and midface elevation techniques, fat preserving blepharoplasties, hairline sparing brow elevation techniques, many different lasers, lip lifts, etc. The face is now viewed three dimensionally (i.e. 360 Facelift concept) rather than as a surface to span skin across.
The net result for the patient is that the indications for facelift surgery are changing. It is now possible to offer patients significant improvements, even for patients in their early 40's. By no means is a facelift appropriate for every 40-year old; in fact the opposite is true. It is the select patient whose appearance often depends on projecting youth and vitality, who has anatomy favorable for facelifting techniques that becomes a candidate.
The differences after surgery are typically subtle. The media are full of examples of celebrities who have had ill conceived surgery. It is the work that you don't see that is most clever.
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Facelift - Think physiological age, not chronological age
I am glad this question was asked because I answer it frequently in my practice. Some of my patients are "older" at 40 than others at 60 based on their lifestyle, health history, and other physical issues.
In general, most 40 year olds do not yet have the indications which would necessitate a facelift, or are what would be described as "early" facelift candiddates . However, I have certainly seen many women in their early 40's with evidence of jowls, midfacial descent, and obliquity of the neckline (the angle between the jaw and neck is less defined).
A "traditional facelift" is really a structural surgical midface, jowl, neck elevation achieved through elevation of the deeper facial soft tissues, contouring of the neck, and removal of excessive skin. Patients with the changes described above will certainly benefit from a facelift, but this leads to another question I frequently hear: What do I need? Since their is no medical need for elective facial cosmetic surgery, the answer I give is more in relation to what bothers a patient.
The answer is: Assuming no major medical issues, if you have the indications for a facelift and the aging changes bother you, then you are a good candidate for a facelift. Sometimes other procedures, such as eyelid surgery, forehead lift, and/ or facial resurfacing may be indicated depending on the patient.
If the indications for a facelift are minimal, you are likely to be underwhelmed by the result and you may be much more pleased with laser treatments (results vary depending on what laser is used) and/or fillers. It is best to consider what your aging changes are, find a surgeon you are comfortable with, understand what the various treatment options will offer you, and make your choice accordingly.
Consider Autologous Fat Grafting
The contemporary approach to surgical rejuvenation of the face consists more and more of an attempt to restore facial volume and contour, in an attempt to emulate youthful facial features. My personal approach to facial rejuvenation is to first maximize repositioning and recontouring of facial aesthetic areas, and to remove only as much tissue as is necessary.
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Patients under the age of 50 get the best long-tern results from facelift procedures
According to a recent American Society of Plastic Surgeon’s report, patients under the age of 50 get the best long-tern results from facelift procedures. Mini facelifts or maintenance lifts in younger patients provide the longest lasting improvement with higher satisfaction rates ten years post-procedure. In the study, patients who underwent a facelift before the age of 50 showed “remarkable maintenance of their youthful appearance”.
Younger patients are can be good candidates for facial rejuvenation procedures. We are seeing more and more patients in their 40s coming in wanting a more youthful appearance. For some patients a mini-facelift can be done in the office under local anesthesia with minimal recovery. A facelift or mini-facelift can take years off a patient’s face now and into the future. Having the procedure now will typically get longer lasting results with a less dramatic initial change in their appearance.
It's anatomy, not age that counts with a facelift
Cosmetic surgery modifies anatomy. This may or may not translate into changes of aging. This is no operation that makes a person younger. An operation changes anatomy that may produce the perception of more youthfulness. Some things like typical blepharoplasty can actually make a person look older later in life. So all things being equal, age itself is not a qualifier for an operation. The anatomy is. You have to analyze your anatomy and determine why it is you look the way you do. It may have to do with your facial bone structure, your relative amount and distribution of fat or the amount and quality of skin. These are not strictly age-dependent. Determine what is going to make you happy and then decide with your surgeon the reasonable methods to achieve that. Different patients will require different solutions. Don't fixate on age. Just look at your anatomy.
It sounds as though you are being given good advice and...
It sounds as though you are being given good advice and that much of your problem may be volume loss rather than loose skin, sagging tissue, or gravitational descent. While rarely a facelift is reasonable on a 40 year old, usually it is reserved for those over 45 to 50. It depends on the anatomy and what you describe are not typically why a facelift is done. Fillers and fat injections are probably best for you for now.
Facelift or fillers
40 Is Not Too Young For A Facelift If You Have Significant Aging Changes
Thank you for your question. You are correct, most non surgical facial rejuvenation methods require repeated treatments and in the end may cost you more than a Facelift. In addition, although non surgical options are very effective, if you have significant facial laxity none of them will achieve as good a result as a properly performed Facelift.
If your only issues are sunken cheeks and hollow eyes then Facial Fat Grafting and Transconjunctival Blepharoplasty with Composite Fat Grafting may be all you need.
However if you have early jowling and neck laxity then a Facelift is your best option.
It is not your age but whether you have facial aging changes that can be corrected with a Facelift that is important.
See an experienced reputable Board Certified Plastic Surgeon. If you have changes that a Facelift will correct and you want to correct them that is a decision for you to make in consultation with your surgeon.
Facelift at 40 is an option
While you are not too young for a facelift, it may not be your best option. The key is to find a facial plastic surgeon who performs a wide variety of procedures then sit down and discuss your goals for surgery. The surgeon can then guide you through your options and suggest the best procedure to get your desired results. At 40 you may even be a great candidate for a mini-facelift!
Facelift at 40 years old
Forty is on the younger end of the spectrum for this surgery. However, we all age differently and certainly our expectations/preferences for our appearance also vary. Typically, if genetic factors conspire to make us develop jowls or neck skin laxity at a younger age, and if this is visible and bothersome, an experienced surgeon may evaluate you and agree that surgery is an option. It is important you find someone you trust who can give you an honest opinion, and tell you 'no' if it is simply too early.
Hope this helps.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.