Which type of Facelift will suit me? I'm 42 with mild nasolabial and marionette lines, sagging cheeks. (photos)

At 42 I wanted to look younger (mild nasolabial + marionette lines). I thought cheek augmentation would help. I had cheek augmentation Nov 2014 the cheek augmentation failed (right implant removed owing to infection & left one, I didnt like the look). Now I decided to go for facelift plus implant removal at same time. 1 dr recommended SMAS + implant removal + fat PRP (3 months post SMAS) to cheeks. Does SMAS suit me? If not which technique does? Will left implant removal affect result? Thanks!

Doctor Answers 15

Multiple facial surgeries- where will it end?

You are on a tricky course:  cheek implants in, cheek implants out, debating which facelift technique will guide your next look.  Are those pre auricular incisions and alteration in the ear shape on the right side view?  If so you've already had some facial tightening!

Rather than seek a specific technique, seek a surgeon who can look at your goals and design a customized approach of how to get there.... reasonably.

If you continue with ill advised surgeries and without a single surgeon who has your fiduciary interest in mind, your face will soon be a lumpy mess.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 134 reviews

Facelift for Me?

First I'm sorry that you had a bad experience with the cheek implant surgery. The remaining implant can be removed but you do have poor cheek definition. If you decide not to revise and replace the implants consider Voluma injections which will improve the contour. Looking at the pictures you submitted I doubt you would 
need more than a mini-lift. Fat injections or fillers would augment your naso-labial grooves and marionette lines.Consider a chin implant which would improve your jawline and anterior neck.  I would be more specific after examining you cheeks and neck. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Age 42 and questionable candidate for facelift

First of all, you need resolution of the cheek implant problem. While discussing this with a surgeon the physical exam in person will help to decide whether or not a facelift is indicated. From your photos a limited lift may be helpful but I disagree with some of the suggestions utilizing fat or some fillers shortly after removing the implant.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Which type of facelift

Thank you for your question and photos.  After what you went through I would be very careful with your revision surgery.  Make sure you go to a Board certified plastic surgeon who performs a lot of facelift surgeries.  Make sure you see plenty of before/after photos before proceeding.  SMAS repair is very common with a traditional facelift.  At your age and laxity you would need more of a mini lower face and necklift.  Nonetheless seek some in person appointments with Board Certified Plastic Surgeons who perform lots of facelifts.  Best of luck to you

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.7 out of 5 stars 31 reviews

Cheek Augmentation facelift in a young looking 42 year old Asian Female

You are dealing with several issues here which you must consider very carefully.  You have implants, likely malar implants, which you would like to have removed.  This removal would be done from inside the mouth and leave some deep soft tissue excess and loosening around the cheek.  The next thing is you have some skin excess in front of the ear on the right which I'm not sure what that is from the photo.  You also seem to have some acne scarring in the anterior cheek.  The final thing is that you are of Asian descent.  Asian patients age very very well. This means that they not only look younger externally, but internally have significantly thicker tissues with more reticular/ligamentous attachments.  In a patient such as yourself who already appears young and has good facial definition, a SMAS plication techniques will fail.  the only type of lift that will adequately address healthier tissues such as yours is a complete deep plane lift in the cheek.  Otherwise, I would not consider anything less especially following implant removal.  Lasering can also be done to improve the skin quality at the same time.  With regard to fat grafting you should also be very careful.  If you choose to fat graft following removal of the implants you must do so with the intent of doing it over several sessions.  You are someone who can very easily be over filled and over volumized and with fat grafting, that can't be reversed.  This is because you have a well-volumized Oval face and fat will only add volume to camouflage shadows and highlight the more superior portions of the midface such as the zygoma.

Overall, the only durable and reliable way to lift the cheek in a patient with your skin and tissue characteristics is to do a comprehensive deep plane cheek lift.  A transtemporal midface lift will not last and will not improve skin quality either.  A SMAS lifting technique will fail.  If you do choose to go ahead with a SMAS technique it has to be an advanced type like a lateral smasectomy or extended smas technique which not many people do and then it will likely have to be followed by several sessions of fat augmentation to avoid irregularities.  Careful trying to fill the small creases around the melolabial folds with fat.  In your face this will very quickly produce a rounded amorphous appearance.  The fat injections if done should be done to provide anterior and lateral projection of the bony cheek / malar eminence.

Ben Talei, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 30 reviews

Lite-lifts, facelift, and cheek lifts.

Lite-lifts, facelift, and cheek lifts.
From your photos you appear very young. Additional cheek volume can be accomplished with fillers such as sculpture and Voluma.
The  lift is a modified facelift that has shorter incisions and quicker healing. It also does a very good job on elevating the cheek and in combination with some type of filler should give you the results that you want

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

What type of facelift is best for a 42-year-old?

 You should not choose a specific technique but rather a very experienced surgeon who does natural work. I am not certain from your pictures that you need a facelift. I would need to see you in person to determine whether the gain is worth the cost. Facelifts do not help marionette lines. Your cheek implant can be removed or a different type implant used. All of these should be discussed with your surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews

Which facelift technique?

From your photos, it appears that you do not need a face lift.  However, an in person examination would better define this.  You appear to be a candidate that would benefit from fat transfer for volume replacement. Removing the left cheek implant or replacing the right cheek implant would help improve symmetry.  You should consult with an American Board of Plastic Surgery certified plastic surgeon.

Todd C. Case, MD
Tucson Plastic Surgeon
5.0 out of 5 stars 54 reviews

Which type of Facelift will suit me? I'm 42 with mild nasolabial and marionette lines, sagging cheeks.

Physical examination is essential to give you an accurate opinion. However, based on your photos- I'm not sure you really need a facelift. If you like the cheek fullness it may be worthwhile to attempt reinsertion on the failed side. Fillers to the nasolabial folds/ or fat grafting will improve this area. The neck and cheek lift in my opinion may not give you a markedly noticeable and impressive result at this time.

Possible Mini Facelift

From the pictures you have provided, and considering you have labeled your condition to be “mild,” I would suggest that you look into the mini facelift. This surgery has the same implications of the traditional facelift, but on a smaller scale. As the name suggests, the mini facelift is generally efficient in treating patients with subtler wrinkling and more moderate skin sagging. It also provides more noticeable, longer lasting advantages over injectable fillers. Contact a board certified facial plastic surgeon near you to schedule a time to consult in person and to discuss the possibility of a mini facelift. 

Sam Rizk, MD
New York Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

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.