Michael Valdes, MD (retired)

First, the disclaimer. Photos are not a substitute for an in person consultation with your board certified plastic surgeon. Than said, let’s talk about what stands out in the photos.

On the plus side, you are a pretty woman with an attractive facial structure. In the views you provided your neck looks good. (A true lateral with your chin in neutral would be of help too to determine if there is significant skin laxity but unless that’s dramatically different from the views provided, a face and neck lift would probably be “overkill” at this stage.) It also appears that you have a nice botox result.

I agree that you have lost volume in your cheeks and could benefit from filler (Radiesse, Voluma or fat) in that area. In addition, consider having a little filler injected into the pre-jowl sulcus to help hide your developing jowls. (Also, in many patients, a little botox injected into the platysma just below the jowl helps to lift it as well.)

In your photos, the hollows under your eyes are quite pronounced and are a significant contributor the aged appearance you dislike. Often, filler injected into the hollow trough under your eyelids will help correct this. (I like to use Belotero or Restylane in this area.) Sometimes the lid “puffiness” it too great for fillers alone and surgery is required. (Here again a true lateral view would be of help.)

Consider working on your skin to recapture its youthful “glow.” In the photos your skin shows some significant pigment problems and an overall “dullness.” Products such as Lytera, Retinol and TNS essential serum from SkinMedica can help. But, they can only take you so far and you may wish to add chemical peels, microneedling or laser treatment into the mix.

I know it sounds like a lot but you don’t necessarily have to address all the areas simultaneously and I think you will be happy with the results.

 

such as Radiesse or your body's own fat. Voluma is the new kid on the block while Radiesse has been around for over a decade and is a wonderful volumizer. It works very well in the cheeks and is considered a "semi-permanent" filler that can last 1 -2 years. (However, in my experience, 9 -12 months is a more realistic expectation.)
Fat can work wonders too, But, unlike Radiesse and Voluma treatments (which generally do not have much, if any, "down time," fat does have a considerable period of down time (usually 2 weeks or so when you really look swollen, bruised and deformed.) On the plus side, when the fat grafts "take" they are permanent.

Conceptually, the technique is similar to fraxel laser treatments in the sense that it causes microtrauma to the upper layer of the dermis (the second layer of the skin) which ultimately leads to the creation of both collagen and elastin. Both lasers and microneedling stimulate collagen production by triggering the healing cascade with the release of chemical mediators such as transforming growth factors. Importantly, the collagen produced after microneedling is normal “basket weave” collagen instead of the linear scar collagen created by lasers. Also, unlike laser treatments, the normal dermal papillae and the epidermal basement membrane are preserved. Since the skin structure is preserved, treatments can be repeated as needed over time without the buildup of the unwanted skin changes or scar tissue that frequently follow laser treatments.

Your photo didn't upload but I can offer some general advice about the condition you describe. In my office, I've had good results treating hypepigmentation with medical micrneedling (and with chemical chemical peels.) The device that is used for medical microneedling gives much more precise control over the treatment than you would have with a dermaroller at home. (I'm concerned that, if you do it yourself, you might make things worse rather than better.)
If you would like to try something at home, I've found that a topical cream called Lytera (made by SkinMedica and available in many plastic surgeons' and dermatologists' offices) is helpful in many patients with your condition.  Retin-A and Finacea work well in combination with Lytera and you should consider consulting with a board certified plastic surgeon in your area who performs microneedling.

A lot of the "sad face" you're seeing is due to the excess skin hanging over the top and pulling down the sides of your belly button. (If you just had excess tissue below, it would be more of a "scream" face!) In addition, the amount of excess you have will really require an incision of the length used for a full tummy tuck. And, a full tummy tuck will eliminate a lot more of the stretchmarks. There are a lot of good board certified plastic surgeons in your area that will be able to help you. (It's not a "fun" operation to have, but I'm confident that you'll find that the results are well worth it.)