I'm 42, I Show All Kinds if Droopping After I Already Had a Facelift at 29. I Know a Facelift Doesn't Last Forever But? (photo)

...the last thing I expected was to look as if I never had one in the first place and look even worse only 13 years later. Why would my skin do this especially at such an early age and after such a drastic procedure. Is there anyway for my face to not look so long? I never had a long jaw in my younger years. Would fillers work for me or will the weight of the fillers just cause more sagging? Am I that unfortunate that I have to get facelift #2 and I haven't even hit 45 yet? Thanks for your help

Doctor Answers 15

Types of facelifts and their extensiveness, their limitations for volume loss, & setting a foundation for supporting volume

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
As a cosmetic oculofacial cosmetic surgeon for 20 years, I’ve done a lot of facelifts. Generally, people who come to me are not younger than 50, but there are exceptions. One of my exceptions was a 42-year-old woman of Irish descent who had some genetic sagging at the jowl area. Unfortunately, she was always asked if she was the grandmother of her 2-year-old child. She had a limited facelift to enhance the jawline.

Facelifting covers a wide range of procedures. A facelift can be a limited mini-lift where there is a small amount of skin removed and the tissue below the skin called the SMAS (superficial aponeurotic system) is tightened in a limited fashion. It can also be an extended face and neck lift where the platysmal bands are addressed with an incision made under the chin and a larger flap is made.

Deciding whether or not you need another facelift has to be in context of your goals. I wrote a book a few years ago called “The Fine Art of Looking Younger” where I explained that it is important to understand the genetics of facial aging, including volume loss. Interestingly, some people are actually happy about volume loss as they aged because when they were younger they had a little bit more fat, and now feel they look more structured or defined.

In your situation, you have to discuss with your doctor what percentage of your look is related to volume loss and what is related to sagging. When I look at a patient, I move the skin and tissue to get an idea whether or not a facelift will help and what kind of facelift is suitable. We work out a plan of whether or not they’re ready to do the facelift. From my perspective, depending on the person’s lifestyle, I make a decision to support the structure of the face in place before adding some volume and fillers. Unfortunately, a lot of non-surgical physicians overfill their patients to save them from a facelift. When fillers are placed in skin that is very saggy, the elasticity is stretched and makes the skin look amorphous. Fillers should be done in a limited and strategic way when someone has very sagged tissue.

As a cosmetic surgeon, I also tend to be very focused on lifestyle. Physical appearance is reflective of what you do in the inside. A healthy lifestyle means avoiding toxins such as cigarette smoke, excess alcohol, lack of sleep and stress. In addition, it is important that you have an examination and a consultation first. You’ll get a lot of opinions about adding volume and lifting based on your photos alone, but having a consultation and finding a doctor who resonates with your desired look and understands you will help you make a rational decision about the outcome. Remember, it’s not always about lifting, rather it’s about a strategy of restoring volume and the elements of facial aging. I hope that was helpful, and thank you for question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Lift or volume restoration

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You appear to have a good bone structure, but you have lost significant volume in the central portion of your face, which accelerates the aged appearance.  Temporary fillers - Juvederm, Sculptra, etc - would help to restore the volume and youthful appearance, but this would be only a temporary solution.  If you liked the results of the temporary filler, a more permanent solution (using your own fat to replace that volume - known as structural fat grafting) would be a good option for you.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 12 reviews

Second Facelift at age 42?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

To my eye, your aging related changes happened primarily through volume loss. I would not recommend another facelift but filling - whether with injectables or fat grafting is at the end up to you and your doctor. Lifting alone will leave you disappointed!

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

How long will facelift results last?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

On average, most people will find that the changes from a facelift will last around 10 years.  This can vary with each person, depending of many factors such as age at facelift surgery, skin type and subsequent facial volume loss that occurs over time.  People who are younger, tend to have better facial volume and skin elasticity which gives a natural result that is maintained longer. From your pictures, it appears that your neck and jawline has held up well over the past 13 years from your surgery but your face has significant volume loss in your cheeks, around your mouth and probably your temples (although not really seen in this photo).  This is what is giving your face a longer appearance.  Adding volume to your face will actually lift your cheeks and slight excess skin in your lower face. Your volume would be best replaced with Sculptra or fat grafting, which are better for larger ares of volume restoration.  From your limited pictures, you have time before considering a secondary facelift surgery. 

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Facial aging includes sagging from gravity, loss of elasticity, loss of volume, dynamic lines and skin changes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Ever person experiences all of these 5 changes. Some start earlier than others. Treatment is directed by patient priority. A facelift will resuspend facial skin and muscles to treat the first two: gravity and elasticity. In a young patient, under 50, it may last up to 12 to 15 or so years. The older you get, the less it lasts, meaning until you get back to where you were.

From the photos posted, it looks like you might benefit from facial filler. If you need a lot of filler, Fat and Sculptra are often good choices. For smaller areas, Restylane, Juvederm or Radiesse.

For some mild tightening along the jaw line, Ulthera may help as well.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

How long does a facelift last

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Most facelift procedures will look well for seven to ten years, so it is not inconceivable that a second lift after 12 years is an appropriate choice. Your photo shows a face which lacks volume and this might be an important part of any furture rejuvenation procedure.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

I'm 42, I Show All Kinds if Droopping After I Already Had a Facelift at 29. I Know a Facelift Doesn't Last Forever But?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based on your picture, it looks like you need volume (with a filler like Scupltra or Artefill) and not a facelift. See a Board Certified plastic surgeon or facial plastic surgeon for a complete evaluation.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Secondary Faceflit

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

"Facelift" is a general term and we would need more information to give you better informed opinion.  Additionally, it would be more helpful to have before and after pictures from multiple angles to better evaluate your results.  As others have said, and I agree, 29 is young for a primary facelift.  It would be interesting to know what type of lift was performed and to see before and after pictures.  From what I can see see now, it looks like you would benefit from volumizing procedures such as fat grafting and may not necessarily need a facelift.  However, without an examination, it is difficult to give specific advice.  


Good Luck. 

Facelift or Fat Grafting, Second Time Around

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

My impression is that it is more of a volume loss issue than a skin/muscle problem.  Although you have provided only limited photos, I believe you would benefit from volume enhancement, such as fat grafting or Sculptra.  You will be supprised how when volume is added, you will fill your own skin!  Additionally, for some minor laxity a deep chemical peel or laser resurfacing can be very benefitial.  Don't dispare, this information is meant to be encouraging.

Arthur N. Falk, MD
Albany Facial Plastic Surgeon

Volume Loss at Age 42

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

My first comment is that a primary Facelift at age 29 sounds somewhat premature.  A Facelift will generally "wear well" for about 10 years, but a Facelift at age 29 was likely to have been a fairly limited procedure.  Based on the limited photo shown, I feel that the biggest aesthetic problem is loss of facial volume.  I would suggest seeing a Board Certified facial Plastic Surgeon or Dermatologist about facial volume replenishment with either Sculptra or fat grafting.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 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.