Ali Riza Öreroglu, MD

Based on what you’ve described, you are indeed a suitable candidate for a deep plane facelift — or in some cases, a lower facelift — even at age 45. The changes you're noticing, such as jawline looseness and the formation of marionette lines following weight loss and fat transfer, are not uncommon and are not solely age-related. Factors like gravity, skin type, genetics, and volume loss all play a significant role in how and when facial aging appears. A deep plane facelift is especially effective in cases like yours because it lifts the deeper facial tissues, not just the skin, resulting in a more natural and long-lasting outcome. To further enhance facial balance and symmetry, especially in the upper third of the face, a temporal lift can be considered. Additionally, a lip lift can help refine facial proportions and improve the harmony between the upper lip and lower face. It’s important to understand that facial rejuvenation isn’t about age alone — it’s about the quality of the tissues and how they’ve responded to time, gravity, and volume changes. Early intervention in suitable candidates like yourself often leads to better, more durable results.

In patients like you—age 54, with minimal wrinkles but noticeable skin laxity—a lower facelift alone is often not sufficient to achieve the best, long-lasting results. In such cases, I recommend a deep plane facelift or a total facelift, which addresses not just the skin but also the deeper facial tissues, repositioning them to restore natural, youthful contours. Given the presence of sagging in the neck area as well, a necklift should be performed in combination to ensure a harmonious transition between the face and neck. To enhance volume, improve symmetry, and achieve a more balanced result, we often incorporate fat grafting to areas of volume loss. Additionally, to further refine facial proportions and correct any imbalance between the upper lip and lower face, a lip lift can be considered as part of the overall plan. Of course, to determine the most appropriate approach for you, an in-person evaluation is essential so I can assess your facial anatomy and tailor the treatment to your unique needs.

In cases of sudden facial sagging and volume loss, the primary step is to correct tissue laxity. A deep plane facelift, which effectively lifts the midface and jawline, may be the most appropriate option. Once the facial structures are repositioned, fat grafting can be performed to restore volume in areas such as the cheeks, temples, and under the eyes. This can also lead to improvements in skin quality over time. However, with such rapid changes, it is important to first rule out any underlying medical causes such as weight loss or hormonal imbalance. For an accurate treatment plan, high-quality photos from multiple angles—or ideally, an in-person consultation—are necessary.

Typically, after a SMAS plication and neck lift, it is recommended to wait at least 3 to 5 years before considering another facelift. This allows enough time for the tissues to fully heal and for your facial anatomy to stabilize. Since it has only been 9 months since your previous procedure, it's generally best to wait a bit longer unless there are significant ongoing concerns. If the SMAS layer was not damaged during your initial surgery, a deep plane facelift can be a highly effective option in the future. This technique lifts and repositions the deeper facial structures, offering significant improvements in areas like the midface, jowls, and jawline. To address volume loss and facial hollowing, fat grafting is another excellent option. It uses your own fat to restore fullness to areas such as the cheeks, temples, and under the eyes, and it can also enhance skin quality over time. If you're noticing a crowded or tired appearance around your brow and eyes, a blepharoplasty (eyelid surgery) may help refresh and open up that area. While a few photos can give a general sense of your concerns, multiple high-quality images from different angles—or ideally, an in-person consultation—are essential for developing a personalized and effective treatment plan.

After reviewing your photos, it’s clear that the tissue damage and loss of elasticity in your face can no longer be effectively addressed with minimal or non-surgical treatments. Therefore, I recommend a deep plane facelift surgery. This technique allows me to reposition the deeper tissues and effectively lift the midface sagging, providing you with a natural and long-lasting result. During the procedure, I also perform fat grafting to restore lost volume, creating a balanced and more youthful appearance. In your case, laser treatments and other non-invasive options would be insufficient. Based on my experience, this combined surgical approach is the most appropriate and effective solution for you. Of course, after a thorough physical examination, I tailor the treatment plan specifically to your individual needs.