44 with concerns of downturned mouth and lower face sagging - time for lower facelift? (Photos)

Question

I have had both Botox and filler to address my downturned mouth and lower face sagging-neither seem to work well. Should I consider a lower facelift at this point or alternative treatment such as Morphus 8 and additional filler? I had both within four weeks of this photo

Nelson Lee Novick, MD · Answer

Frankly, before you jump into expensive, invasive surgery that engenders a significant post-surgical downtime or invest in many of the expensive "bells and whistles" energy-based gizmos out there with fancy names that are backed much more by marketing hype and social media buzz than hard science, you might wish to make sure to consult with an experienced, board certified cosmetic dermatologist injector expert. At least from the photos provided, the kinds of issues, I.e. down-turned mouth and lack of a defined jawline, are rather common problems treated on a daily basis with gratifying results by the use of robust HA fillers in most active practices.  
I hope this helps and saves you time, money and needless frustration and disappointment. 
Best of luck.

Gary M. Horndeski, MD · Answer

A lower facelift is a possibility but another alternative is an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

It would be very difficult to say whether lower face/neck lift or a selected neck lift would be a better option in your case. In person or teleconference consultation with a board certified plastic surgeon with good reputation in facial rejuvenation is recommended. Good luck.

Randal Haworth, MD, FACS · Answer

At 44, it’s very common to see early lower-face changes — and your experience (Botox/filler not giving you what you want) is a clue that this may be more about tissue descent and ligament support than just volume.
From your photos, you appear to have early jowling and downturning at the mouth corners, which often does not respond dramatically to filler, and too much filler can actually make the lower face look heavier.
What Usually Works Best
Corner of mouth (DAO) Botox can help if muscle pull is a big part of the downturn, but it won’t lift sagging tissue.
A small amount of strategic filler can support the prejowl sulcus in some patients, but it’s limited.
A lower facelift / mini-lift becomes the most reliable option when the issue is sagging/jowls, because it actually repositions tissue rather than masking it.
What About Morpheus8?
RF microneedling can help with skin texture and mild tightening, but it generally won’t correct true jowls or mouth-corner descent the way a lift can. It’s best thought of as a skin-quality tool, not a structural lift.
Practical Next Step
If you want a more definitive, longer-lasting change and you’re already unimpressed with injectables, it’s reasonable to consult a qualified, board-certified plastic surgeon about:
a mini/lower facelift (often paired with a small amount of neck/lower-face contouring if needed)
and whether you’re a candidate for a less invasive lift vs waiting
Good luck!

Darryl J. Blinski, MD · Answer

Based on posted photos you may better have mini face neck lift either Endo Laser combination. Fee $6,000-$8,000. Again best yo virtual consult with

44 with concerns of downturned mouth and lower face sagging - time for lower facelift? (Photos)

Answers (5)

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