What kind of facelift do I need? (Photo)

Question

When i turned 40 last summer people thought i was in my 20s and now everthing has dropped.

Donald Groves, MD · Answer

Hello and thank you for your question. From what I can tell based on the pictures you have provided, there is some minimal jowling present on both sides. This occurs with age as the soft tissues of the face start to descend and as we lose volume from fat atrophy and bone loss, resulting in the characteristic changes of facial aging. You do not appear to have significant excess neck skin. You have possible early platysmal banding in your neck. Based on all that, I would recommend a facelift/necklift for you. A facelift would be the best way to address the soft tissue descent and jowls to improve jaw definition and restore a more youthful appearing face and neck. At the same time, facial fat grafting can also be done to address volume loss and help further improve facial balance and harmony.
Regarding your eyes- I do not see any obvious brow ptosis, excess upper eyelid skin, or bulging lower eyelids ("bags under eyes")- only prominence of your tear troughs on both sides. Given that, you could soften the lower eyelid/nose/cheek transitions with facial fat grafting, as mentioned above. 
With all that said, it is difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos you have provided, especially given only a frontal view for both pictures. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Semih Yildiz, MD, FEPOBRAS · Answer

From the photo, this looks more like early lower-face laxity/jowling and cheek volume change than severe facial aging. You may be a candidate for a lower facelift or mini/lower-face lift, with or without a neck lift depending on your neck skin, platysma bands, and under-chin fullness. The exact technique, such as SMAS or deep plane, should be chosen after an in-person exam because photos do not show skin thickness, tissue mobility, or neck anatomy well enough.

At age 40, it is also important not to over-operate. Sometimes volume adjustment, skin resurfacing, neuromodulator treatment, or targeted filler/fat grafting is part of the plan, while surgery is reserved for true laxity. If the change really happened suddenly over only a few months, ask your doctor to consider weight change, dental/bite changes, hormones, stress, or other medical factors before proceeding. A consultation with a board-certified facial plastic or plastic surgeon can show whether a small lower-face lift or a more complete face/neck lift is appropriate.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. You may be a candidate for a mini facelift to revitalize your appearance by reducing jowls, tightening your skin, and angulating your jawline. This procedure can provide a firm, smooth, and youthful-looking result that is long-lasting in many patients.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to discuss your concerns with you and determine the best course of action to help you achieve your aesthetic goals.

Cem Berkay Sinaci, MD · Answer

Hello, as the volume of your face is saggy, not lost, my suggestion would be a high smas face lift to make the lower cheek volume upper around the cheek bone. The jawls are also adressed in this technique. For a more holystic look I would suggest a temporal lift at the same time to make the cheek-temple transition smoother and make the lateral parts of the eyebrows higher. Regards

Stephen Prendiville, MD · Answer

As you know, there is no "need" for a facelift for anybody.  However, based on the photos shown, here is some degree of aging change (jowls) along the jawline.  These changes would not prompt action by many people, but I have had patients who have historically looked good, want to continue looking good, and seek to address these changes early.  If you decide to take action, the best strategy is to do it right.  The overly expensive, short duration, and quasi-effective treatments like thread-lifts and energy devices usually leave patients frustrated, and aren't comparable to surgery.  A deep plane facelift is the  best approach, in the  right hands, to reposition facial soft tissues in a natural way.  It's difficult to assess the changes in your neck based on the photos shown, so an anterior (platysmaplasty) approach may or may not be indicated at the same time, only a consultation would help determine this. The key point is: in the right hands.

Zoran Potparic, MD · Answer

Only on the basis of in person evaluation, a board certified plastic surgeon, expert in facial rejuvenation, could give you a more meaningful advise. Good luck.

Cory Bovenzi, MD · Answer

Hi and thanks for the question! You are just starting to see the signs of jowling and would be a great candidate for a mini lower facelift. People have different definitions of mini facelifts but overall, they have the effect to smooth that jawline, ad volume to the cheeks, and get rid of jowling by moving the facial muscles back upwards to where they used to be. It does this while minimizing downtime and avoiding the use of drains.

Randal Haworth, MD, FACS · Answer

I would recommend an endoscopic mid-face lift to provide volume to your malar/cheek region and give you more of a heart shape face, counteracting the tendency of the human countenance to become rectangular with age.

Of course, an « in person » exam is necessary.

I hope this helps,
best of luck !

Of course, an « in person » exam is necessary.

I hope this helps,
best of luck !

William C. Harris, MD · Answer

If you’re interested in a durable and natural facelift, I strongly believe the deep plane facelift is an excellent option. This technique releases the deeper tissues that are actually descending with time as well as key tether points in the face. In addition there is no tension with closure, which provides an impactful result without any pulled appearance. The main areas it addresses are midface, jawline, and neck. I hope this helps and best of luck in your journey.

Gregory S. Keller, MD, FACS · Answer

Any type of facelift that you have should have a mid-face included.  I prefer deep plane facelifts with the mid-face.  This relieves the tired, mad, sad look that we all get as we get older.  The mid-face is an essential to relief the RBF.  Only about 5% of surgeons perform the mid-face.  Look for a board certified Facial Plastic Surgeon to ask.

What kind of facelift do I need? (Photo)

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