I have facial sagging and drooping. Why and what should I do? (photos)

Thank you for your question. Overall, you have pretty favorable facial structures that should be able to withstand the effects of aging quite well. However, there are several aging changes that contribute to somewhat older appearance of your face. Each of these changes by itself is fairly subtle (hence hard to pinpoint) but in combination, they make your face appear much older than it would look otherwise. Three things, in particular, stand out. First, deep frown lines contribute significantly to the aged appearance of the forehead and make you look "worried". Second, hollowness under the eyes makes the cheeks look saggy and give your eyes a tired look. And finally, early jowls change the overall shape of the face, shifting facial volume from the cheeks (where it looks attractive and youthful) to the lower face and jawline.The good thing is that, at this point, all of these aging changes are quite easy to reverse. The first two problems would require a fairly small minimally-invasive treatment. Frown lines would respond quite well to injection of Botox (Dysport, Xeomin). Hollowness under the eyes would improve with the help of a filler. The jowls is the only aging change that would require more significant procedure to get rid of. I would recommend a facelift the most reliable and long lasting solution to the sagginess of the lower face and neck. Other treatments could be tried, but (in my opinion) would have a limited and short lasting effect on the appearance of the jowls.Best wishes!Dr. Konstantin

You do appear to be exhibiting ordinary laxity that is common for anyone in their early 40s. Gravity and loss of volume combine to start causing the problems, and there is nothing wrong with starting to improve things at your age. The key is to look totally natural with anything that is done. Small things would be Botox injections between the eyebrows and fillers to the folds between the nose and mouth. Either skin peels or Fraxel are done to improve the skin complexion. To lift some of the sagging, I am not a fan of the noninvasive procedure such as UItherapy because I haven't seen a significant long term result. You are a good age for a mini facelift, which can be done under local anethesia, and gives a nice long term result for the jawline. A combination of these procedures will keep you looking fresher without really being noticeable to other people.

A short scar facelift is a great option for many people. The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day, you can shower the next day, there're no scars behind the ears and you can wear your hair up anytime and most patients take no pain medicine. The result is usually the same in selected patients as a full scar facelift but it really depends on your exam.
Surgery is not for everyone. In today's day and age, there are many nonsurgical options to consider although surgery usually gets the most improvement specifically of the neck and jowls.
I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of mini facelifts and neck lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations. 
I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. It is possible to #combine #surgeries. In fact, I commonly recommend other procedures to go accompany a facelift, such as blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result. The best procedure approach will be discussed in greater detail during your one-on-one #consultation. I invite you to visit PacificCenterPlasticSurgery.com to view a complete list of surgeries commonly performed. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives. It is extremely important to seek a board certified plastic surgeon highly trained with your desired procedures. I also encourage you to look at before and after photos of the surgeons actual patients. Also, reading patient reviews of those who have had combined surgeries will be beneficial. Gathering all of this information will help you make a well-informed decision.

Fraxal Fraxal doesn't work. Fillers would work in areas that are depressed such as the periorbital as well as nasolabial fold. One can make a case for facelift but this is based on the expectations of the patient. Botox can improve unwanted expression lines particularly between the brows.

We have found that adding a number of minimally invasive treatments together you can get a nice improvement of your face. We named it the Pearl Lift. That is a combination of Ulthera to tighten, Fractionated CO2 laser for skin color and texture and Voluma to restore a youthful cheek. There is minimal downtime and this can be altered for your specific needs. 

As we get into our 40s, we start to see an increase in the signs of aging. This includes some descent of the cheeks and the formation of early jowls. Wrinkles can form and we can also lose some volume in our upper face. The mainstays of treatment for these issues tend to be either surgery or fillers or both. Your plastic surgeon will evaluate the condition of your skin and the various options and discuss with you the expected outcome with either filler treatments to improve fullness of the cheeks or wrinkle treatment versus surgeries to improve the jowls or perhaps the lower eyelids.

Would be helpful to see a profile photo as well. Volume loss can be addressed with fat transfer, fillers like juvederm, Voluma. If you have excess skin- it usually is treated with face/neck/cheek lift. Seek an experienced Board Certified PS.

That is a difficult question as there are many available options for someone at your stage of the ageing process. The best answer for you is to seek a personal consultation with someone you trust, discuss your specific areas of concern and express your aesthetic goals and ideals. It is important to have boundaries, both physical and financial and then find the solution that will be best tailored for you. Best of luck!RegardsDr Guy Watts

Tough to tell from just one picture what is going on.  Really need an in person consultation.  However from this one picture, your cheeks do appear pretty flat, and you have a rectangular appearance to the face, as opposed to a more triangular shape which we associate with youth.  So perhaps a facelift and/or filler to the cheeks.  Ulthera is best for neck laxity and jowling.  See a couple of surgeons for opinions.