Am I a suitable candidate for a facelift despite two very different surgical opinions? (Photos)

Question

I am a 46-year-old woman concerned about lower-face/jawline sagging, upper-neck laxity/crepey skin and a small localized fat pocket under my chin. I also have an asymmetric fatty bulge beside my mouth, considerably more prominent on the left. I have consulted two plastic surgeons and received opposite recommendations. Surgeon 1 recommended a deep-plane facelift extending into the upper neck to improve my lower face, jawline and neck. He believes the bulge beside my mouth is buccal fat and advised doing the facelift first, then considering conservative buccal-fat reduction later if it remains bothersome. Surgeon 2 declined to operate, saying I have insufficient indication and that any improvement would be marginal and largely disappear once the initial postoperative tightness/swelling settles. He recommended injectables for the lower face and fractional laser for my neck. He also thinks I have a muscle on the left cheek pulling my cheek inward causing more of a depression than on the right cheek. My main goal is meaningful improvement of my jawline/lower-face contour, upper neck and small under-chin fat pocket. Based on my photos, would you consider me a reasonable facelift/face-and-neck lift candidate? Would you expect enough lasting improvement to justify surgery? Does the asymmetric mouth bulge appear consistent with buccal fat? And would a facelift improve the bulge?

Don W. Griffin, MD · Answer

Thank you for your question. Based on the lower face and neck skin laxity, I don't believe non-surgical options will offer much improvement especially in the areas that are of major concern to you-the central neck and medial cheek areas. A face and neck lift with contouring or repositioning of the buccal fat pads, fat grafting and possibly micro liposuction are options that can be considered by your surgeon based on your internal anatomy to address the medial cheek bulges. Often, a combination of these will give the best results. The neck lift portion of the procedure will be the best way to address the neck laxity.

Zoran Potparic, MD · Answer

Based on these photos you seem to be a good candidate for face lift. Only on the basis of in person consultation, an experienced board certified plastic surgeon with good reputation in facial rejuvenation could decide whether lower face/neck lift or posterior extended neck lift would be better solution for you. Good luck.

Jeffrey H. Spiegel, MD · Answer

A facelift is effective, but a lot for your concerns. Fractional laser and injectables may be too little. I'd do Junera. This is an under-the-skin laser that can tighten these areas, in the office, in a powerful way without you needing a facelift.  Some swelling for a few days but no stitches needed.

Ronald J. Edelson, MD · Answer

At your age I’m not surprised that there would be differing opinions. There’s no right or wrong answer here. It’s up to you whether or not you want to undergo a facelift at this point in your life

Muhsin Yilmaz, MD, FEBOPRAS · Answer

At 46, based on the concerns you describe, I would consider you a reasonable candidate for a face and neck lift. Your main concerns&mdash;lower-face and jawline laxity, upper-neck skin laxity and localized fullness under the chin are all issues that surgery can address more definitively than fillers or devices.
A well-planned lift should provide a meaningful and long-lasting improvement, although it cannot stop the natural aging process.
As for the asymmetrical bulge beside your mouth, I would not assume it is simply buccal fat based on photos alone. There are several structures in this area that can create fullness or asymmetry. I would first correct the overall facial and neck contour and then reassess that area before considering any fat removal.

Stephen Prendiville, MD · Answer

Thank you for your question.  The 3 criteria I look at in deciding if a patient is a surgical candidate are as follows: 1) good overall health, no acute medical issues, 2) aging indications which surgery can address, 3) a desire to address these indications.  For these reasons, I tend to agree with Surgeon #1 in that you are a surgical candidate with less advanced indications.  Your neck will not improve with anything but surgery. I sincerely doubt that buccal fat is playing any role in the concerns that you have (the bulge).  However, if so, the buccal fat can be addressed at the time of the deep plane facelift.  This bulge  will likely improve but may not completely with surgery.  Fillers and energy devices will not achieve the goals that you have mentioned; fractional laser alone for your neck isn't going to have very much benefit.

Am I a suitable candidate for a facelift despite two very different surgical opinions? (Photos)

Answers (6)

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