Am I a good candidate for an endoscopic mid facelift? (Photo)

Question

I have droopy eyes as you can see. I'm considering getting an endoscopic mid facelift, is that the right call for me? I want to get rid of my undereye sagginess.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. While a personal evaluation of your skin is necessary to make the proper recommendations, I am only seeing undereye hollows and cheek sagging based on the photo you provided. A facelift might be too aggressive of an approach to address these concerns. Less invasive procedures you might consider would be injectables like Botox and dermal fillers for a non-surgical facelift, a PDO threadlift (uses dissolvable sutures to lift tissue and tighten skin for a noticeably younger appearance), or RF microneedling (Profound RF or Virtue RF) that combines the rejuvenating benefits of microneedling with the stimulation of radiofrequency (RF) energy to renew the skin from the inside out. A combination of procedures can offer optimum results as well. The best way to determine the right approach to achieving your goals would be to schedule an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon can assess your skin, determine the best procedure or combination of procedures, and ensure the best possible outcome.

Alan Gonzalez, MD, FACS · Answer

Hello @linasjourney thank you for your question. In making decisions, it is important to consider all the physical aspects and possible outcomes. An eyebrow tail pexy procedure can improve the tired appearance of the eyes. For more information and recommendations it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Hakim Said, MD, FACS · Answer

Hi Lina, 
There is a long history now of surgeons trying to make the face look younger by lifting the deepest layer of the face at the level of the bone. You should be very specific about what your surgeon is exactly going to do, but that is the idea behind endoscopic mid face lift. Unfortunately that layer is not where we age, and it just makes people look weird to do that surgery. At best you don't look too weird and there is very little effect. Aging skin loosens superficially, and also in its midlayer (SMAS) but not really at the bone layer (periosteum). Find someone who offers correction at the right levels. In your case, you look young already and I would not recommend a lift at all. You just don't have as much fullness in your cheeks as you would like, so it leaves a hollow appearance under your eyes which looks older than the rest of your face. That can be corrected with a much easier surgery: adding natural fat in that location will make you look healthy and youthful, with essentially no scars, while preserving your natural look. 
Hope that helps!

Ronald J. Edelson, MD · Answer

I’ve never been impressed with midface lift endoscopic or otherwise. You are best off leaving well enough alone. Your eyes look fine

Dean P. Kane, MD, FACS · Answer

Dear linasjourney,

Thanks for sharing your photo. I do see the cheek hollowing and cheek sagging you are concerned about. A singe photo is not enough to fully evaluate the this issue. I also see that there is brow and eyelid asymmetry as well. A full in-person evaluation is necessary. 
My recommendations include:
1.	Please consult with a very talented and skilled Board Certified Plastic Surgeon with a lot of face and eye experience. 
2.	A mid-face lift may be an excellent option but must be compare with the benefits and limitations of surgery and injectables.
3.	Consider using facial fillers for the cheeks and / or PDO Threadlift.
4.	You may also benefit from brow elevation with “botox” (or other injectable muscle rebalancing). 
I hope this is helpful. I wish you the best!