32, Mid face is not as lifted as before - Fillers vs facelift? (Photos)

Hello and thank you for your question! At 32, it's not uncommon to start noticing midface volume loss and early signs of skin laxity. The flattening of the midface and changes under the eyes you mentioned are typically due to a combination of fat pad descent, bone remodeling, and early collagen loss.
Here are some treatment options based on your concerns:

1. Non-Surgical Lifting & Skin Tightening
Morpheus8 (RF Microneedling): Helps tighten the skin, stimulate collagen, and slightly improve volume over time, especially around the eyes and midface.

Thermage FLX: Uses radiofrequency to tighten and lift skin by stimulating deeper collagen remodeling—ideal for subtle lifting in the mid and lower face, including pre-jowls.

These are great options if you're not quite ready for surgery and want to prevent further sagging.

2. Volume Restoration
Hyaluronic Acid Fillers: Can restore midface volume, improve under-eye hollowing, and offer a natural lift when done conservatively.

Sculptra: A collagen stimulator that works gradually to restore lost volume and improve skin quality over time—excellent for long-term structural support.

3. Blepharoplasty vs. Botox
Upper Blepharoplasty is usually reserved for true skin redundancy. If you're unsure, a skilled provider can assess whether it's skin laxity or brow position that's contributing.

Botox can gently lift the brows and open the eyes—ideal if you're not yet ready for surgery and have mild heaviness.

4. Endoscopic Midface Lift
This surgical option is indeed trending in younger patients who have noticeable midface descent but good skin quality. It repositions deeper tissues rather than adding volume. It's best suited for someone who:
Has minimal to moderate sagging
Wants a longer-term structural lift without filler
Is not seeing enough improvement from non-surgical options

If your primary concerns are volume loss and early skin laxity, starting with non-invasive options like Morpheus8, Thermage, or subtle filler may provide the results you're looking for without downtime. If you're already noticing significant descent and want longer-term results with minimal maintenance, then a consult with a facial plastic surgeon about an endoscopic midface lift might be worthwhile.

A personalized consultation with an experienced injector and/or facial surgeon can help determine what will give you the best aesthetic outcome. It’s not always about doing the most—it’s about doing what fits your anatomy and goals.

Best of luck in your journey!
Genie Alexander, RN BSN
for Anna Petropoulos, MD FRCS
Center for Classic Beauty
Boston & Danvers, MA

When considering options for mid-face rejuvenation, it's important to weigh the benefits and suitability of both fillers and surgical options like an endoscopic mid-facelift. Here are some considerations:

Dermal Fillers: Fillers can be a great non-surgical option to restore volume to the mid-face and under-eye area. They can provide a subtle lift and improve contour without the downtime associated with surgery. Fillers are typically a good choice if you're looking for a less invasive option with immediate results.

Endoscopic Mid-Facelift: This minimally invasive surgical procedure can provide a more significant lift and is often suitable for younger patients who have early signs of aging but do not require a full facelift. It can address sagging in the mid-face and improve the appearance of the lower eyelids and cheeks.

Upper Blepharoplasty: If you have concerns about excess skin or drooping in the upper eyelids, an upper blepharoplasty can be effective. This procedure removes excess skin and can create a more youthful, refreshed appearance.

Botox: While Botox is not typically used for lifting, it can be effective for addressing dynamic wrinkles and fine lines, particularly around the eyes and forehead.

Consultation: It's crucial to consult with a board-certified plastic surgeon or dermatologist who can assess your specific concerns and anatomy. They can provide personalized recommendations based on your goals, skin quality, and the degree of volume loss or sagging.

Ultimately, the decision between fillers and surgical options depends on your desired outcome, the extent of changes needed, and your willingness to undergo surgery. A professional consultation will help determine the most appropriate treatment plan for you.