Asian female, age 40. Collagen loss and sagging. Can you recommend a procedure? (photo)

A deep plane facelift can lift the cheeks and jowl area with improved longevity for long time correction. The scars are hidden around the ear and will be hardly noticeable.

Your facial aesthetics are still in very good shape. However, you should consider starting aggressive skin resurfacing treatments to boost collagen, improve lines/wrinkles, tighten skin and improve pigment. Choose a clinic that is very versed in treating Asian skin types safely (you do have a higher chance of post treatment hyperpigmentation).

If you have too much fat then I do not recommend anymore fat transfers to the face. One thing you can consider is 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. The procedure takes 1 hour to perform under local anesthesia and costs $4,000. The other alternative is a mini face lift. This can pull up some of the jowls and cheeks.

Best Wishes,

Gary Horndeski, M.D.

It sounds like you are a candidate for a Mini-Facelift. My favorite technique is the MACS short scar Mini-Facelift. Developed in Europe, it is the ideal approach for the younger patient, not ready for a full facelift, or patients who desire a less invasive procedure with a shorter recovery time. It addresses both the mid face area (especially the jowls) as well as the neck, if needed. Come see me or another board-certified plastic surgeon in our area. Good luck.

I would suggest radiofrequency with micro-needling, like Secret, to help tighten skin and improve your collagen. Sculptra injections could also be done to help fill in thin areas and give overall smoothness to your face, especially in the cheek areas.

The Indian line is typically caused by fat atrophy and aging. Fat transfer can be used to fill in areas of dimpling and hollowness along the line. However, due to potential unevenness caused by fat graft atrophy, additional fat grafting sessions are often recommended for optimal results. For aging-related concerns, a mini facelift can be considered to address underlying skin laxity and achieve a more rejuvenated appearance