I'm 46, Requesting a Plan to Age Gracefully. Any suggestions? (photos)

Multiple signs of aging, including jowls, neck sagging, tired eyes and dull skin.I am including pics of the WORST. Also included a couple made up and of existing scars on chin. I have always disliked the lack of definition in jaw line, but I do not want to ever look "done" or like a different person. In addition, I clench my jaw a LOT, and look old and "cronish" when I do so and my lips are crooked and thin. Looking for advice on dental and surgical options, and long term plan.

Doctor Answers 33

Natural Facial Rejuvenation

I would do your homework and find a reputable Facial Plastic Surgeon who has a lot of experience.   The most natural results result from a balanced approach.  Unfortunately, there has been an explosion of options with little insight into what is required for a balanced approach by many well intended doctors who simply just don't have the experience.   

In other words if all you do as a doctor are injectables, you may not consider surgery as an option.  Surgery done well is not seen as it looks very natural.    Over injection in the wrong places leave a patient looking "done"   and the casual observer may think "this person has had some bad plastic surgery"   when in reality they have had no surgery at all.  

For example we use a very comprehensive evaluation and balances approach with almost 25 years of facial rejuvenation.  Approximately 80% of our patients undergoing surgery have volume restored using a fat transfer for a treatment plan that is highly tailored to the individual.  I hope this makes sense

Latham Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

I'm 46, Requesting a Plan to Age Gracefully. Any suggestions?

It's a great time to start managing the aging process. Based on your photos- I would recommend facelift/ neck lift in combination with upper lid blepharoplasty to remove the excess skin on your upper lids, and possible fat transfer. This combination of procedures will provide the best result in my opinion. Seek an experienced Board Certified PS for in person exam

Facial rejuvenation options

Thank you for the question and the photos.  There are many options for facial rejuvenation and which ones would be best for you depends on your opinions as well as the preferences of your plastic surgeon.  I would recommend a full face and neck lift as well as fat transfer to the face and particularly the under eye area.  The full face and neck lift may seem overly aggressive when compared to "mini type facelift procedures" it will be the most powerful at correcting all of the aspects that you are concerned of and providing the longest lasting result.

I hope this helps.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 153 reviews

Management of facial aging.

Patients now have lots of surgical and nonsurgical options for facial aging. At some point time I think you would get an excellent result from a facelift. This may be to send in your opinion and the use of Botox particularly in the periocular area may be of benefit. Fillers can help augment the cheek decreasing the apparent development of jowls. Conservative upper eyelid surgery should give slightly more upper lid exposure. I don't see any need for lower lid surgery at the present time.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Cheeklift and Upper Eyelid Surgery options

Your photographs seem a little dark.  If your goal is to improve your appearance and you are not oppose to having surgery at 46.  Then I think you could benefit from an upper eyelid lift to help with your tired look .  I also think you may consider a cheeklift for your jowls.  If you are not ready for a cheeklift then I would suggest you consider having AFI  which is your fat injected into your cheeks.  I do not believe non-sugerical injections would be the answer to a long lasting improvement for you.

John Ward, MD (retired)
Phoenix Plastic Surgeon
4.9 out of 5 stars 66 reviews

Options for face

Thanks for the photos. In general you look good though I understand your concerns. Non-surgical options would include some fillers to your cheeks (conservative) and pre-jowl areas (to help hide the jowls). Kybella could help reduce the small amount of fullness beneath your chin and a scar revision could improve the scar. CIT treatment can help the texture of your skin. Non-surgical skin tightening (Viora Reaction) can also be useful but is a little less predictable. Hope this helps.

What are my options for multiple signs of aging?

Thank you for a great question and for sharing your concerns and pictures.  With early aging changes like yours, you have multiple options both noninvasive and minimally invasive available to you...ranging from injectables to nonsurgical skin tightening to minimally invasive laser skin tightening.  You are welcome to review the nonsurgical section on my website AtlantaFaceAndBody.com which discusses some of these options.  I would also be happy to discuss your options in person.  I hope you find this helpful. Best wishes!

Consult with a Board Certified Fellowship Trained Facial Plastic Surgery Specialist.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

You have many options

In my opinion, there is rejuvenation (making someone look better), and there is preservation (keeping someone looking great). I'd recommend you see someone who can offer you ALL options regarding both. There are non-surgical AND surgical options that can make you look great, and feel great. A thorough consultation with discussion of ALL of your options would be the best decision, so you can determine what the best treatment plan is for you. Consider someone who specializes in facial rejuvenation and facial preservation.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Aging face

You are showing age appropriate changes with early jowl formation, mid face volume loss etc. You have many options that could help you age well without looking "done". The best thing you can do is establish a relationship with a facial plastic surgeon who can work with you now and in the future to optimize your aesthetic appearance as you continue to age using both surgical and no surgical techniques. Best regards. 

Sean R. Weiss, MD
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Facelift vs non-surgical options

Ultimately, a surgical face lift provides the best contouring for someone with moderate or severe laxity. This procedure could include tightening your underlying musculature to give you a better contour and also removing the excess skin laxity. Together this allows for a much better face and neck contour. In some instances, some liposuction is also beneficial to reduce the submental fullness.  This would be the most impactful to address the jowls in the photos.  

However, there are effective non-surgical options for you. I would recommend Ulthera if you are looking for something with no downtime, or Profound if you could tolerate some downtime. Ulthera is an ultrasound based energy that heats the underlying tissue and stimulates collagen in response. Profound is a radio frequency microneedling device that allows for the creation of Elastin, collagen and hyaluronic acid and hence restores some of the lost elasticity in the face. It has more visible downtime with the possibility of some swelling and bruising that diminishes in about a weeks time.

Dermal fillers may also give you more cheek (mid face) definition and soften the jowls to a lesser degree than surgery, but create a nice contrast.  In addition, Kybella for the neck region would help define this region without surgery.  Lastly, you may want to consider Botox for the masseter region as this can help thin the lower sides of the face which is a result from masseter hypertrophy (due to jaw clenching).

I would visit with a board certified plastic surgeon who has the portfolio of non-surgical options in your area who can help explain the treatment options for you and the limitations of each option, both surgical and non-surgical.

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.