Do I need a Breast Lift? If so, what incision? (photos)

This is always difficult to answer without an in person exam to perform measurements and determine skin quality. I really do not prefer to do a lift on patients in your age range for multiple reasons. I will say a downward facing nipple is not corrected by an implant alone.

Your nipples are located below your breast fold and are pointing downward, therefore a lift is probably the most suitable option for you. This would raise your nipples as well as make them project more forward, rather than downward. If you were to only get breast augmentation, the implants would sit rather low on your chest as they would need to be centred behind your nipples. You would probably need an anchor incision, although that could be further discussed with your surgeon.

Thanks for your inquiry and excellent pictures. I believe at the minimum you would need a peri-areolar lift, best to get an in person evaluation to discuss your options and best of luck.