41 and have had significant sagging and fat loss in my cheeks - Would a facelift be the best option to fix this? (Photo)

Question

I’m 41 and have had significant sagging and fat loss in my cheeks over the past 2-3 years. The uneven areas on my nasolabial fold area really bother me and make me look tired. Is there a facelift or procedure that would fix this?

Keshav Magge, MD · Answer

Thank you for your question.  Based on your photo you have some early jowls and are developing more pronounced nasolabial folds.  I believe you would benefit from a deep plane face and neck lift with some conservative fat grafting. I think that would give you the most harmonious and longest lasting result.  Best to speak to a board certified plastic surgeon with experience in this.  All the best,

Andrew Miller, MD · Answer

From the photos, it appears that you have only some mild jowling so you don't need a whole facelift. A facelift is not performed for hollow cheeks and nasolabial folds either. A fat transfer would work very well to improve the folds and fill out the cheeks some. At the same time, you could undergo a mini facelift to tighten the jawline, which will make a great combo procedure. Be sure to see a facial specialist for consultation.

Steven Curti, MD · Answer

As most of the surgeons on this site will tell you, it is very difficult to answer your question without seeing you in person to do an exam and get a better history. With that being said, the deep plane facelift is designed to release and lift the skin, fat and SMAS layer of the face. It is powerful at helping lift sagging tissue especially in the jowls and soften the nasolabial folds. I would caution that asymmetry on the face is very normal and is not something that is often corrected by facelift surgeries. Based on the limited information and photo I think it would be worth a consultation with a surgeon to review your options.

Muhsin Yilmaz, MD, FEBOPRAS · Answer

At 41, a midface lift or facelift combined with carefully planned fat grafting could be considered, depending on your anatomy.
If the main issue is cheek descent with volume loss and uneven nasolabial folds, simply adding filler may not be enough. Lifting the cheek tissues and restoring lost volume can give a more balanced and refreshed result.
The exact procedure would depend on how much laxity and volume loss you have, so an in-person examination would be important.

Octavio Gonzalez, MD · Answer

Hello! Thank you for your question. It’s a pleasure to help guide you.
Based on your age and what you describe &mdash;particularly the laxity and loss of volume in the cheeks, as well as the more pronounced nasolabial folds&mdash; I believe you could be a good candidate for an endoscopic deepplane facelift.
This procedure allows us to work on the deeper layers of the face through small incisions, repositioning the cheek tissues and improving the transition between the midface and the nasolabial folds, rather than simply removing excess skin.
In your case, I would also consider a neck preserving approach, with limited incisions around the ear. One of the advantages of the endoscopic approach compared with a traditional facelift is that it can avoid the more extensive scars around the ear and along the hairline near the temple.
The exact surgical plan, however, depends on your skin quality, degree of laxity, facial anatomy, and the amount of volume loss. During an in person or virtual consultation, I could determine whether this technique is the best option for you and whether adding volume restoration would further improve your result.
The goal would be to achieve a natural, refreshed appearance while maintaining your unique facial features.

Serdar Bora Bayraktaroglu, MD · Answer

Combining a facelift and fat injection (often called structural fat grafting) is an exceptionally effective approach for comprehensive facial rejuvenation. Why Combine Facelift and Fat Grafting?Two-Part Aging Process: Aging involves both deflation (volume loss in the cheeks, temples, and under-eyes) and descents (sagging skin and jowls forming the lower face). A facelift alone repositions fallen tissues but cannot replace lost volume. Fat grafting restores youthful fullness. Transferring your own purified fat softens deep folds, improves skin quality via stem cells, and provides a smooth, natural foundation that enhances the structural tightening of a deep-plane facelift. Consult a board-certified plastic surgeon.

Oliver Chang, MD · Answer

Based off your limited photo - there's no show of your eyes or brows to evaluate but there is noted small jowls along with nasolabial folds resulting from facial laxity (aging + volume changes). An endoscopic approach would be of benefit to keep scars in the hairline hidden to improve the middle face which by lifting that area will decrease nasolabial depth and potentially pull up the jowling at the level of the mandible. Fat grafting is a great adjunct to add volume to areas that have been lost with aging and to help rejuvenate to a more refreshed youthful appearance. Seek out a few different opinions to see which one you like best prior to making a decision. Hope this helps.

Warren Schutte, MD · Answer

From photos provided, you are too early to make a facelift worth your while. Instead, focus on skin rejuvenation with products like UltraClear. You can achieve total skin resurfacing (improve texture/tone/pigment and keep collagen stimulated) and also utilize their "micro-coring" technology to help achieve tighter skin and jawline.

Mert Demirel, MD · Answer

At 41, cheek hollowing and nasolabial fold heaviness can come from both soft tissue descent and volume loss. A facelift can improve sagging and reposition descended tissue, but it does not always fully correct cheek fat loss by itself.
If the main issue is lower face sagging, jowling, and deep nasolabial folds, a facelift or midface/lower facelift may help. It can lift the soft tissues and create a fresher, less tired appearance. However, if the cheeks have truly lost volume, volume restoration is often needed as well.
Options for volume loss include fat grafting or conservative filler. Fat grafting can be combined with a facelift in selected patients and may give a more natural correction for hollow or flattened cheeks. Fillers can also be useful diagnostically because they show how much improvement volume replacement alone can provide.
The uneven areas around the nasolabial folds may not be completely erased with surgery. Over-lifting or over-filling this area can look unnatural, so the goal should be softening and balancing rather than removing every fold.
My advice would be to consult a facial plastic surgeon or plastic surgeon who can assess whether your concern is mainly descent, volume loss, or both. In many cases like this, the best plan is not facelift alone, but a combination of facial lifting and careful volume restoration.

Bulent Cigsar, MD · Answer

Based on your photo, I don’t think your nasolabial folds are the primary issue. What I notice is mild to moderate midface volume loss and early descent of the cheek fat pads, which can make the folds appear more pronounced and contribute to a tired appearance.
At 41, you may not necessarily need a full facelift. The most appropriate treatment depends on whether volume loss or tissue descent is the dominant factor.
If volume loss is the main concern, restoring cheek volume with fat grafting or hyaluronic acid filler can soften the nasolabial area and provide a refreshed appearance. If there is significant descent of the midface tissues, a facelift&mdash;particularly one that addresses the deeper facial layers, such as a deep-plane facelift&mdash;can reposition the cheeks and improve the nasolabial folds more naturally than simply filling the folds themselves.
In many patients your age, the best results come from combining a conservative lifting procedure with fat grafting, rather than relying on either treatment alone. Restoring volume where it has been lost while repositioning descended tissues generally produces a more youthful and natural result.
An in-person consultation is essential to determine which component&mdash;volume loss, tissue descent, or both&mdash;is contributing most to your appearance. From your photo, however, I would focus on treating the cheeks rather than the nasolabial folds themselves.

41 and have had significant sagging and fat loss in my cheeks - Would a facelift be the best option to fix this? (Photo)

Answers (14)

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