What kind of lift do I need? (Photo)

I am only 34 but my face is already sagging. I have jowls and a slight double chin. It is a family trait, not a weight issue. I am 5'3 and 115lb. What kind of lift do I need?

Doctor Answers 11

Cheek lift candidate?

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Although  the photos you have enclosed are a good representation it is still not a substitute for a clinical exam. Judging from your photos you would benefit at least from submental lliposuction.  You would also appeared to benefit from Lipo suction of the Jowl area. The real question is whether you also need a cheek lift to take up the loose skin. The amount of elasticity and sagging in-your-face cannot be judged from a photo. So therefore to determine whether lipo suction alone or  cheek lift surgery with liposuction is your best option you should see a board certified plastic surgeon who is experienced in facial plastic surgery 

Sacramento Plastic Surgeon


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Facelift technique results in a younger and natural, but not “done," look. The surgery is done in a deeper plane which results in a full-thickness skin and subcutaneous tissue flap, which is redraped and elevated vertically over a repositioned SMAS layer. This avoids the "windswept" effect of pulling back too severely only the top layers of soft tissue.

Chin implant surgery has long been touted as a simple operation that reliably gives good results. 

The adequacy of chin projection should take into account several variables including sex, the effect of occlusion on lower lip position, the thickness of the chin pad, and the depth of the labiomental fold. When these variables are not considered, implant augmentation may result in a chin that is unnatural and too large, particularly in a woman.

Cheek Lift Considerations

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The Midface has been the focus of great attention lately. The latest fillers that create large amount of volume where previously there was none has been the culprit.

It has become an epidemic among Hollywood's finest where their unrecognizable visages are overwhelmed with excess cheek volume. Cases of this include Lindsey Lohan, Joan Rivers and many more. In reality, this epidemic stems from two issues;

  1. Newer fillers like Volume and Sculptra are easy to use and add volume for those patients that are losing facial volume over time (this is a good thing).
  2. People see the improvement from the outset and get addicted thus losing all judgement when it comes to looking natural.

The concerns about mid face stem from several aging issues occurring as we age.

  1. The lower eyelid sags leaving a poof of excess skin and muscle at the lower edge of the eye. This is the first component of the shadow that makes people look old and tired.
  2. The cheek mound sags as a result of gravity, tissue stretch and muscle pulling (smiling, eating, smoking) that results in the cheek mound sagging toward the floor and toward the mouth (down and in). This sag results in a hollow just below the eyelid, creating a depression that we call the tear trough. With the shadow above and the depression from volume loss the tear trough is the prime component of a tired mid face.
  3. Increased pigmentation around the eyes in those of darker complexion makes the entire aging process accelerate.
  4. Finally, the muscle that surrounds the eye, called the orbicular oculi muscle can get swollen in some people. This swelling, called a festoon, is very difficult to treat.

What are the treatment options.

  1. Volume replacement (Voluma, Fat grafting, SculptraRestylane Lyft) are large molecule fillers that can add volume where volume has been lost. Many people say that these fillers lift the Midface, however I am of the opinion that no lifting occurs but the camouflage give the appearance of lift. The downside to these fillers is that with the exception of fat, the fillers are denser than the fat it replaces and as such, during the normal smiling movement, the filler reacts like an unnatural lump of clay and not so much like the cheek fat it is designed to replace.It is this overreach that makes people look like monsters. My advice is to use volumetric fillers as a subtle improvement to restore contour, not to create a cheek mound that did not exist previously. Furthermore, my choice is to use fat grafting, especially in the tear trough and around the cheek because it is soft and mimics the tissue characteristics of a normal cheek (a natural smile).
  2. Cheek Lift - a cheek lift or mid face lift is one of the easiest and shortest recoveries of facial rejuvenation surgery. This is ideal for putting the sagging cheek tissue back where it belongs. It will lift the cheek up and outward, lift the marionette lines and get rid of most problems along the jawline. The cheek lift will NOT correct the tear trough along the inner 1/2 of the under eyelid, and for that reason a cheek lift is often joined together with fat grafting to create the best, most natural results.
  3. The pigmentation that some people get around the eyes can be improved with skin lighteners, but this is a temporary fix and will need to be used continuously. There is no other treatment that adequately gets rid of tis problem.
  4. Finally, Treatment for festoons is not great. In the earliest stages, application of Preparation H can help. As they get worse, some filler at the inferior edge can camouflage the ridge. At its worst, direct excision of the skin and underlying muscle can make it go away, but with the scar. For some patients, this is a good trade-off.
I hope this clarifies the considerations around the MidFace. If you have any further questions, please read my book "A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

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What kind of lift?

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It would be really unusual to need a lift at 34, but it's possible that you might benefit from it.  A lift is a powerful procdure and you only get a few of them in your lifetime before your skin elasticity gives out.  You'd kind of hate to burn one now!If your skin elasticity is good enough (and that's best judged by an in person exam), you might do well with some form of liposuction.  You might also benefit from fat grafting.  Our current techniques are very natural looking and last a really long time, if not forever.

If it's something you think about on a daily basis, set up a consultation or two with a board certified expert in your area and see what options they suggest.

Robert K. Sigal, MD
Reston Plastic Surgeon

Do I need a lift?

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It does appear from your photos that your face looks a little drawn.  I agree with you that some of this may be due to your genetic predisposition and the shape of your face.  However, I would not recommend having any surgical lifting performed at this time as I think you would get a better and more natural improvement with smaller procedures and/or non-surgical options. Your chin appears relatively smaller in relation to the rest of your face, and this would be a good area to consider augmenting with either a chin implant or with facial fillers.  You appear to be an excellent candidate for a newer injectable product called Kybella, which is specifically used to treat double chins and unwanted fullness in this area.  This product was approved by the FDA earlier this year and should be more readily available for treatments by the end of this year.  You may also consider facial fillers for the tear trough or upper cheek areas to simulate a cheek lift.  This can be done in a way that does not make your cheeks necessarily appear larger.  Frequently, the appearance of the nasolabial folds will improve somewhat after filling these areas as the face achieves a more balanced and youthful shape.  However, the nasolabial folds can be filled a little as well if desired.  Best, Dr. Gregory Lewen

Gregory D. Lewen, MD, FACS
Miami Oculoplastic Surgeon


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I think that you need the most minimal of procedures to correct your concerns. Liposuction of the neck and jowls should tighten these areas and give you a more defined neck and straighter jaw line. Smartlipo using the laser will also help to tighten the skin. This can be performed in the office under local anesthesia and has a quick recovery.

What kind of lift?

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  I think a small incision lift would be helpful in addressing your concerns.  Of course, your condition is not severe but there are early changes occurring which are of apparently concern to you.  Therefore, a mini lift, such as an S Lift, would likely be beneficial to you.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 140 reviews

You don't need a facelift

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Thank you again for your question and photograph. While every patient is unique, I generally wouldn't recommend a facelift, including mini lift or s-lift, for anyone in 30's age range. Double chins which run in families can be treated with other plastic surgery procedures. Other better options to possibly consider to improve the lower face, neck, or double chin would be neck liposuction, chin implant, buccal fat reduction, and Botox jaw reduction, for example.

If you haven't already, then speak with a plastic surgeon to perform an examination and review options with you.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Neck lift and chin implant

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 In our practice, a neck lift involves removal of fatty deposits above and below the platysma muscle in the neck, also known as submental fat, and sub--platysmal fatty deposits. A platysma plasty is required  if the sub-platysmal fat has been removed. No skin removal is required. A chin implant would help with the frontal  and side projection  of the mandible due to the weak chin profile that is present.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews


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Based on the pictures posted you are not in need for any kind of facelift.
There is a small amount of fat in the submental area, may be some fullness in the jaw line, mild nasolabial fold.
Examination of the neck to determine whether the submental fat is above or below the muscle. If above the muscle then a liposuction done expertly can improve the area, liposuction along the jaw line may help.
Fillers or fat in the nasolabial area done expertly may soften the nasolabial fold.

Samir Shureih, MD
Baltimore Plastic Surgeon

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.