I'm 36 but Would a Mid-facelift Improve my Long Face and Nasolabial Folds? (photo)

I have noticed nasolabial folds since I was 32 and it is worse on the left side of my face. Since then, I had 2 vials of juvederm ultra injected into my cheekbones and the left nasolabial fold and now, 6 months later, it is already bothering me again. Even right after the procedure, it did not see to do that much. I would like something more permanent and something that would show more improvement, but have been told to wait till I'm older by 2 surgeons. Would a cheek lift solve my problem?

Doctor Answers 26

Endoscopic midfacelift with endotine fixation

There are several points that bear emphasis in answering your question. First, if you look closely enough, you will see that everyone's nasolabial folds are asymmetric, i.e., that one side is always deeper than the other.  

The second point is that the nasolabial fold is a natural attribute of the human face. Even babies have nasolabial folds, and they are pretty young, so the goal is not to eradicate the nasolabial fold, for that would make your face look strangely abnormal. Rather an expertly performed endoscopic midfacelift will efface the nasolabial fold and soften it just so, while at the same time elevating the soft tissue of the midface back to the position it occupied when you were younger.

Another important point for you to understand is that injecting filler into a deepening nasolabial fold does not address the fundamental issue in an anatomical way, but merely "fills in the canyon" from below. This is, at best, a temporizing measure, as you have discovered.  

The nasolabial fold becomes more pronounced with age because the descent of the soft tissues of the midface causes them to overhang the nasolabial fold and this "crowding from above" makes the nasolabial fold appear deeper.  Thus, the definitive anatomic solution to a deepening nasolabial fold is to re-elevate these tissues back to their former position in the midface, and in so doing, remove this "crowding from above" that causes the nasolabial fold to appear deeper.

Another important point to mention is that by repositioning the ptotic soft tissue of the midface back to a more aesthetically pleasing position in the midface, the bizygomatic distance, i.e., the width of the mid-face, will be restored to what it was in youth, and thus there will be an aesthetic improvement of a face that appears too long.  

Lastly, the notion that you are "too young" to benefit from a midface lift is predicated on the assumption that the purpose of such a surgery is to remove redundant skin. But clearly that is not your problem, and that would not be the purpose of performing a midface lift for you. Rather, the purpose of a midface lift is to reposition the soft tissues of the midface, and in so doing change the contours of your face so that your nasolabial folds are effaced (but not eliminated) and the region of your upper cheeks is augmented, giving your face a softer, fuller and less narrow overall appearance.  I believe a midface lift would produce these improvements in your facial aesthetics, and in so doing, help you achieve your objectives in a more long-lasting and pleasing manner.

Los Angeles Plastic Surgeon
4.6 out of 5 stars 47 reviews

Excellent candidate for a mid-face/cheek lift

You are an excellent candidate for a mid-face/cheek lift.  This procedure, with its small, well-hidden incisions, is specifically designed to reposition the mid-face/cheek soft tissue to a higher position--often back to the position where it originally was before the early effects of gravity. 

Not only does this recreate the youthful appearance of volumization in the cheek area, but it also corrects the deep nasolabial folds that you are concerned about.  Not only is this procedure more permanent than facial volumization through injected tissue fillers, it also is more easily tailored to your specific needs and can create a more significant and long-lasting improvement. 

The incisions are completely hidden above the hairline and inside the mouth.  It is a much less extensive procedure than a facelift and designed perfectly for someone your age and to address the concerns that you have expressed here.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 18 reviews

Nasolabial folds at 36

Your best bet would be use of fillers, perhaps a permanent one such as ArteFill.  Surgical lifts are not the best way to treat nasolabial folds in a 36 year old

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Midface lifts are thought to do that. but in my opinion there are other better options

For nasolabial folds and a long face, fillers would be one option. Volumizing would be the best thing that I would suggest for improving the midface.  Traditional procedures tend to change the way you look and they tend to not return your face into the position it once used to be. The aging process is due, in large part, to a volume loss.  The tissues in the face then retract inward and downward. Traditional procedures tended to pull back this tissue keeping it inward but upward and backward, no outward and forward.  So you end up no where near where you used to be.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Facial rejuvination options for younger patients

It is difficult to do a thorough anaylsis of your face with a single picture. My initial impression is that you are attractive with minimal signs of aging.  I don't think that surgery would give you much improvement at this point.

Other options include fillers such as Radiesse or Juvederm. The advantages are that you can undergo treatment with these products with essentially no down time and they can provide a nice result for the nasolabial fold and the cheeks. The cons to fillers such as these are that they are limited in longevity, usually only 6-12 months. Another factor to consider is that you have a limited amount of product to inject unless you are willing to spend several thousand dollars.

Sculptra is a nice option that typically yields long term results with limited to no downtime. One of the cons to Sculptra is that you will not see the results right away and most people require multiple viles which can become expensive.

Fat is a great alternative. Most people have enough fat in the abdomen or outer thighs to yield 50-100cc. The upshot is that there is a large amount of product that can be used to address numeorus areas of aging and the longevity is considerably better than synthetic fillers. The downside to fat is that there is more downtime required with more swelling and more discomfort during the injection process. Another consideration with fat is that at least 50% of the fat will atrophy or resorb and most patients should be prepared for 2-4 procedures to get the desired results although some are satisfied with one application.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Midface lift for nasolabial folds?

I don't think you need a midface lift. I am a big fan of midface lifts. When performed well they help to balance out the face and restore a youthful relationship between the lower eyelid and cheek.. The work best in patients with volume loss in the mid-cheek are and skin that "moves" easily. You might get a little more improvement with micro-liposuction of the actual fold itself if you feel that it is too full and heavy. It's hard to tell from your photos.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

Improving long face and nasolabial folds in a 36 year old

A midfacelift will not address nasolabial folds nor shorten a long face.  The nasolabial folds can be addressed with injectable fillers such as Restylane or Juvederm, though results are temporary.  A long-term solution is to harvest fascia graft at the time of a facelift and inserted into the labial folds for permanent augmentation.  Flat cheeks are best addressed with cheek implants and not a midfacelift.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Facelift at age 32?

What we want to improve is your specific facial esthetics; your age is just a number.  And we like fast-recovery facelifts in young patients because there provide long-lasting facial "house-keeping" before things are "falling apart". But when I assess your photo, I would likely recommend non-invasive treatments (such as Ultherapy and injectables) or conservative facial fat grafting. To have some nasolabial creases is normal; they can be softened with fillers or your own fat. We like to look beyond your creases though and gently enhance your overall facial sculpture. This will best maintain a youthful and soft look.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Mid-facelift and nasolabial folds

I would recommend a fat transfer in your situation not a midfacelift or cheek lift.  You would notice a mild amount of improvement only and traditional lift techniques offer modest improvement of the nasolabial folds in young patients at best.  A vertical facelift will help a little but just won't really give you the bang for your buck like you would expect.  Filler and patience would be my best counsel.  If you continue to get opinions to wait on surgery from differing surgeons you know what the right thing to do. 

Shepherd G. Pryor, MD
Scottsdale Facial Plastic Surgeon
4.6 out of 5 stars 23 reviews

Mid facelift improve long face and nasolabial folds

A midface lift helps to improve the look of a "long face"  by redistributing and lifting cheek volume from lower on the cheek bone to a higher position.   Sagging or drooping of the cheek does begin in the late 20s so it is not uncommon for someone in their 30s to be troubled by this phenomenon.   An endoscopic midface lift (performed with cameras and incisions hidden behind the hairline) is a facelift that I frequently perform on younger patients but typically I would wait until at least the early 40s.   it is difficult to see from your pictures because your eyes are covered but sometimes the same look can be achieved with filler injections or microfat transfer by adding more volume around the eyes and upper cheeks.   The nasolabial folds are improved best surgically with a combination of fat injections to the nasolabial folds and midface lifting.

James C. Marotta, MD
Long Island Facial Plastic Surgeon
4.8 out of 5 stars 71 reviews

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.