What kind of facelift is best for a proactive 35yr old wanting to prevent nasolabial wrinkles? (Photo)

Question

I have been researching mini facelifts, SMAS facelifts, deep plane facelifts, etc. Which one would you advise for me? I don't want to go the non-surgical/filler route because it's expensive long term, less effective, doesn't last, and gives a puffy, wider face look that I don't like. I'd rather just have a facelift or 2 in my lifetime. I started Botox at 30. I want to maintain my face rather than fix it later. I'd like to do the 1st one soon as a preventative measure against deep wrinkles.

Randy Wong, MD · Answer

Mahalo for your photos.  We always try to balance risk and benefit in our recommendations.  Risks may not justify standard facelifting for you, as the jowling and jawline are minimal, and the results would be very subtle.  If you are investing in preventing nasolabial fold development, consider midface suspension methods.  We also offer suture suspension techniques for supporting tissues against gravity that might interest you.  Do seek several consults with board certified plastic surgeons before committing to any procedures of this nature.

Thomas A. Mustoe, MD, FACS · Answer

Your jawline and neck still look youthful but you do have some early skins of tissue relaxation around the mouth. No agree that it is unlikely that fillers woukd achieve the goals of looking natural with meaningful improvement.  The goal of a “proactive@ procedure has to be carefully weighed: the cost , recovery, and risk versus the improvement.  That being said the deep plane facelift with complete mobilization of tne SMAS layer will hove a completely natural appearance with correction of the relaxation around the mouth.  Any procedure that does not adequately release the retaining ligaments that anchor the deeper layer (SMAS) will not last.  Pulling up tissues with sutures without releasing and actually changing their relationship to the SubSMAS layers will not last or risk looking tight.

Bora Ok, MD · Answer

Hi from Istanbul! Nasolabial folds often arise from facial expressions, particularly those made by smiling muscles. If someone frequently uses these muscles and has a substantial amount of midface fat, the folds can become more pronounced. Reducing the activity of these muscles through Botox and elevating the cheek are potential solutions. For your situation, I suggest a midface lift performed via a temporal hairline incision. 
A midface lift repositions sagging fat tissues, enhancing cheekbones and reducing under-eye bags for a rejuvenated look. It also addresses deep lines and wrinkles. For enhanced results, it can be combined with eyelid surgeries and a brow lift.
Hope this helps, best of luck!

Michelle Lee, MD · Answer

Hi there! Your approach to anti-aging is smart. 
Many of my clients have a similar mindset about fillers and non-invasive treatments. Small amounts of filler and some non-surgical devices can be beneficial for the right patient but you aren't wrong that over time, as you get older, doing this continuously can look unnatural and become very expensive. In regards to non-surgical treatments, you can never go wrong with botox, skincare and Sofwave (safe yet effective lifting via ultrasound technology). Because you don't have any obvious lines or excess tissue it may be a bit soon for a facelift but I highly recommend considering the Sofwave in the meantime. 
If you do proceed with a face or neck lift, I recommend the deep-plane technique so that the tension is on the underlying tissues rather than on the skin. This results in a much more natural appearance and longer lasting results. 
I hope this helps!

Ajaya Kashyap, MD · Answer

Thank you for your query. You do not seem to need a facelift as yet. However, to address your specific concern, a sub-periosteal mid-face lift can best improve sagging mid face and Naso-labial folds/wrinkles. Please find a board certified Plastic surgeon who can examine you and help you with your concerns. All the best!

Stephen Prendiville, MD · Answer

First of all, I don't see indications which would support performing any kind a of a lift at this time.  A facelift or variant thereof is designed to address existing indications, but is not an aging preventative procedure. Facelift should not be performed as a method of preventing nasolabial fold formation.  Generally speaking, but not always, patients seeking legitimate surgical correction are in their late 40's to early 50's. On the other hand, patients in this group tend to "wear it better" because of existing skin elasticity and other youthful factors in their skin and facial soft tissues. Lifestyle, avoidance of smoking, excessive sun exposure, a good diet and appropriate sleep are better preventative measures than surgery at this time in your life. Surgery performed before the presence of indications presents the scenario of risk without appropriate reward.

Gianfranco Frojo, MD · Answer

I do not think that you need any type of facelift or necklift currently. If you truly want to proceed, I would recommend a deep plane facelift/necklift. These will last quite a long period of time (20-25 years). I would recommend finding a plastic surgeon with at least 6-7 years of training in actual plastic surgery.

Gregory S. Keller, MD, FACS · Answer

There re several less invasive procedures that are available.  Ulthera is often effective for early facial sagging, and can give a nice result.  It requires an extremely skilled operator to give a nice result without a great deal of pain, and these can be hard to find.  It is the only procedure that is FDA approved to "lift" the face. (others "tighten" skin).  Next up might be a chin implant and the "myellevate" procedure.  Many people do "myellevate" for the neck, but few do the "trampoline" portion of this procedure, as opposed to the "Giampappa" style stitch. Seek out someone who does the "trampoline".  The "my ellevate" procedure requires no incisions (needle holes only required).  Finally, a cheek lift will lift the cheek area.  Mini lifts will not do this.  If you are going to go all out right away, I'd recommend a deep plane lift.  While I perform several lifts for different types of patients, younger patients often need a balanced approach that looks natural and is performed as a unit.  I think that you would do fine with the less invasive options, but certainly would take off more years with a more aggressive approach.

Richard G. Schwartz, MD · Answer

Based on your photos, age, and concern, I would recommend a short scar facelift with the MACS technique.  This utilizes a more vertical lift of the upper neck and cheeks than a more traditional lift.  There is no scar behind the ears as you don't seem to need any skin removal there.  This is excellent for tightening, lifting, and smoothing the upper and lower jowl bulges, jawline, and temples.  It is my preferred technique for younger patients who don't require any significant lower neck work.

Gary M. Horndeski, MD · Answer

At this time, I recommend a lip lift. A lip lift 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 will help conceal the nasal labial folds. This is done in the office under local anesthesia, takes about 1 hour to perform and costs $3,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

What kind of facelift is best for a proactive 35yr old wanting to prevent nasolabial wrinkles? (Photo)

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