I am 46 years old, and I am starting to see the signs of aging. Mini Facelift? Neck Lift? Standard Facelift? (photo)

I am not sure which "Lift" I am a candidate for. I am looking for some guidance.

Doctor Answers 31

There are many options to address early signs of facial aging in a female

You are in an ever-enlarging category of patients that I am seeing in my practice in recent years.  You are a relatively young lady who is starting to notice some of the earliest signs of facial aging.  It is very important, actually I would say extremely important, to recognize these seemingly very obvious and trivial facts.  This is because your situation is much more complex than it appears on the surface.  I think in "the old days" we simply said "you have laxity on your neck (no matter how severe it is or where on the neck it is located)," and we jumped straight to recommending full face and neck lift.  Everybody sort of got the same treatment, and predictably, most people turned out OK (even though they might have gotten more surgery than they really needed or wanted), but some people either had problems that could have been avoided with a more conservative approach, or they simply looked "overdone"  or in some way, unnatural.  Neither of those last two situations is desirable in my opinion.  Fortunately, a lot has changed in recent years - say over the last 10 - 15 years or so - to improve our understaning of facelifting.  We have a much better understanding of what is actually happening in the aging face, and we have many more options to offer to people.

With regard to our understanding of facial aging, we now recognize that this is a complex interaction of loss of volume of the tissues, wherein they become thinner and deflated, and they no longer look “plump and succulent” like they did in youth, and loss of tone or support of the soft tissues, allowing them to sag or even become redundant, elongated, and stretched.  Certain areas of the face are very consistent in how they lose fat, skin, and muscle volume during aging, and that is why we as humans have a “mental picture” of what an “old person” looks like.  Recent studies seem to show that the bones aren’t as involved in this volume loss as the soft tissues, but when the soft tissues overlying the bones become thinner, they drape differently over the bones, creating a hollow, sometimes gaunt appearance.  Additionally, bony irregularities and asymmetry become more apparent to our eye as the bony architecture is now covered only by a thin “top sheet” instead of a nice plump “down comforter.”  In addition to this, the loss of tone in our soft tissues allows them to drape or fall in very predictable ways as gravity and muscle forces take over and move and reposition the loose, redundant tissues.  Thus, we get bands in our necks and folds by the chin, jowls, folds by the sides of the nasolabial grooves, eye bags, and so forth.  Naturally, these processes take place to different degrees in different people based upon a whole host of very important factors including their age, their race, genetics, and family traits, their medical history including smoking and drug use, weight loss or gain, and medical illnesses, and their gender.  Armed with this important information, we can now look at ways to specifically address the anatomy of what is going on, and more importantly, specific ways to address the individual anatomy of each individual patient.  This way, nobody gets a “cookie cutter” approach to facial rejuvenation.

With regard to the second big improvement in facial rejuvenation, namely the issue of having options to offer people, as I said before, at one time we had very few options to offer.  This is because we didn’t have the understanding of aging that we do now, and because technology in both procedures and products was not what it is today.  I also think this has a lot to do with the fact that “traditionally,” or “culturally,” only “older” people requested facial rejuvenation, so there was no motivation on the part of the medical community to even come up with other options.  As younger people began to recognize the changes their faces were starting to experience at an earlier age, and they become more motivated or proactive to do something about that, we in the medical field started figuring out new ways to help them.  Things like minimal access, short-scar, or “mini” facelift techniques were developed, soft tissue fillers were introduced  and their use has been expanded beyond simple lip and dermal line filling, and our refinement of fat grafting technology has exploded such that we now have an excellent and very reliable way of restoring lost volume all over the face.  In this light, we can now see that the facial rejuvenation surgeon, now more than ever, has to balance a very complex interplay of factors to get the best possible outcome for each individual patient.  One of the most important factors that is often left out is each patient’s goals and expectations.  Not everyone wants the same degree of change, and many people want a more subtle result.  Similarly, many people don’t NEED a very aggressive procedure to achieve a very natural and satisfactory result, yet they are often “sold” a more aggressive approach, which they dutifully “buy” because “the doctor knows best.”  Some people don’t want a lot of downtime, and some people don’t have the budget to afford a very comprehensive and complex procedure, and they would be happy with a more modest outcome.  Thus, it is one of our greatest responsiblities to our patients as surgeons to understand this complex situation, recognize all of the options available, and take the time to truly evaluate each individual patient, both from a standpoint of their needs anatomically, as well as their personal goals.  This is precisely the issue that I see time and again in people just like you, and it’s the “category” of patient that I see you in - relatively younger patients with mild early signs of facial aging who are looking for improvement, who want to remain natural in their appearance, but who don’t really know what’s available to them or what is best.  That’s a lot of responsibility for a surgeon.

At this point I need to say a few words about specific techniques and what they are used for.  I can’t really provide a definitive plan for your face, because we have never met, and to do that really requires a personal consultation, not only to examine your face in detail, but to discuss your personal goals and expectations as I outlined above.  However, I’m hoping some of the things I’ll say here will shed some light on the topic for you in general and at least get you started on your journey.  First of all, volume enhancement, while very important to consider, will only address issues of volume loss.  Thus, things like fat transfer or filler injection will be very useful when we have hollowing or thinning of areas of the face.  Things like “tear troughs” under the eyes, or hollowing of the temples, chin, lips, and cheeks are good examples of this.  In some instances, volume can provide some bit of lift and repositioning of sagging loose tissues, much the same as a breast implant can “perk up” a mildly sagging and deflated breast.  However, in the end, if the breast is sagging too much, a breast lift is required to lift it up, and such is also the case with sagging facial tissues as well.  Thus, sometimes we can add a bit of volume to sagging brows, cheeks, or pre-jowls by the chin and plump up the tissues, correct mild sagging, and camouflage areas of unwanted contour, however, if the sagging or laxity is too great, this will not be enough.  I’m concerned that your facial tissues, as shown in your images, while amenable in some areas to volume replacement, won’t be amenable to only this approach of volume replacement, as you have enough laxity of parts of your face, like the jowl, cheek, and upper neck tissues, to necessitate some form of lift.  Thus, lifting procedures are best used when we have sagging and displacement of tissues that is so much that simple volume correction maneuvers won’t suffice.  If we lift tissues when they don’t need it, or if we lift them too aggressively or to a degree that exceeds what is necessary to restore normal, natural anatomy, then we risk not only complications from more extensive procedures, but we can also create unnatural appearances and a “done” look.  This to me is one of the reasons why we had so many “weird” looking people running around who just got “standard” full face and neck lifts without any attention to volume replacement or a detailed approach to their individual anatomy.  

For me, one of the most useful tools in my toolbox for people like you has been a minimal access, or short-scar, facelift, plus or minus some form of volume correction as needed.  Let me first say that unfortunately many surgeons have pursued the profit motive or played the ego game and contributed to the confusion about this issue by proliferating catchy nicknames and trademarks for what amounts to basically the same general concept - a less invasive, more minimal type of facelift, designed to correct milder, less advanced degrees of facial aging.  They may use a new kind of suture or a different way to put that suture in, but in reality, they are still doing the same thing to the tissues, because human anatomy is human anatomy, and there are only so many unique approaches to reversing the changes that occur in the face with aging.  Things like “Lifestyle Lift,” “MACS Lift,” “BellaLift,” “QuickLift,” and “XYZ Lift” are all over the place, and in actuality, they all amount to the same general ideas - shorter scars than the traditional full face and neck lift, less extensive and aggressive dissection under the skin, and some form of tightening, or suspension, of the loose tissues under the skin responsible for the signs of aging that we see.  An important thing to note here is that minimal access facelifts usually don’t do a very good job on extensive aging of the neck.  No facelift or necklift will address crepy, loose, wrinkly skin of the neck, as that is more an issue of the skin tone itself, which requires a SKIN treatment like laser or peel, not surgery, but in instances in which there is also sagging of the platysma muscle, or the deep layer of the neck under the skin, a minimally invasive or short scar facelift probably will not do the trick either.  My rule of thumb on this is that laxity of those tissues in the upper part of the neck - the so-called “suprahyoid” region, above the hyoid bone by the Adam’s apple - can be managed very nicely with the right minimal access procedure performed well.  Extensive bands and laxity of the neck lower than that, probably won’t be addressed, and those will need a more formal neck lift procedure.  I think there is great value in a combined approach with strategic volume replacement as needed, together with a minimal access facelift, especially in younger people like you with milder signs of facial aging and mimimal laxity of the neck.  From what I see, you probably don’t need a full neck lift to get improvement of the neck and jawline issues that you appear to have, thus, you probably don’t need to incur the additional risks and expense that accompany such a procedure.  Again, the lower part of your neck appears to have some skin creases, but the overall tone of the deep tissues that would be addressed with a neck lift appears fine.  Thus, you shouldn’t count some form of minimal access facelift without neck lift out as an option, and you should speak with surgeons who can offer that to you.  It has often been said very smuggly that “mini - procedures produce ‘mini’  results.”  While that may be true to some degree, let me also say that many patients only need “mini” results to achieve their goals, and in those situations, “mini-procedures” turn out to be the best solution.  I acknowledge that there are many patients that are not great candidates for minimal access, or short-scar, procedures of any type - vertical breast lift/reduction, mini-tummy tuck, or, as we’re discussing here, mini-facelift.  The key is not to throw the baby out with the bathwater and say that all minimal access procedures are unworthy, rather it is for the surgeon to understand which patients are the best candidates for those procedures and select them very carefully.  So, I will not tell you at this point that you are for sure an excellent candidate for a minimal access facelift in my opinion, but I will say that it certainly appears that you are, and you should at least visit with surgeons who can offer that to you as an option and show you results wherein they have achieved their goals using that option.  Again, the goal is dependent upon you as much as it is the surgeon’s opinion, so this issue requires some discussion, not just a quick meeting with a resultant recommendation to get the same kind of face and neck lift as the last 10 patients that were seen.  Lastly, as I alluded to above, there are many variations on the theme of “minimal access,” or “mini,” facelift, and the important thing is to  find a surgeon who has a good track record of success with the technique that he or she uses.  This will be the surgeon who has probably evaluated and selected their patients properly and then executed the technique, whatever that is, precisely to get the best results.  Don’t be swayed by the gimmicky terms and trademarks designed to show a false sense of expertise or superiority over one’s colleagues - be savvy when listening to your surgeon describe how they do their technique and what the rationale is for their recommendations.  Educate yourself a bit on the anatomy of the face and how surgeons approach this issue.  I’m not saying that you should invest the time to get a medical degree or anything like that, just have a bit of knowledge about what it is that is going to be done to your face so that you aren’t just blindly trusting someone who seems to tell you all the right things.  Lifestyle Lift went out of business, not because it was dangerous or did procedures that were totally unorthodox - the truth of the matter is that they didn’t really do anything special in the way of surgical techniques.  They met their demise because of fraud in both advertising and consultation, poor practices of evaluating people for the procedure, and unsound medical practices with regard to follow up and evaluation of their results.  Unfortunately, there are still lots of other people out there doing similar things when it comes to facial rejuvenation, so being educated is your best defense against that.  Also, you should only consult with board certified plastic surgeons certified by the American Board of Plastic Surgery, or facial plastic surgeons, certified by the American Board of Otolaryngology or American Board of Facial Plastic and Reconstructive Surgery, and who have extensive experience in all facets of facial rejuvenation, as they are the only ones whose training in these procedures is properly recognized.  They will be the ones best equipped to provide you with all of your options and most likely to produce a favorable outcome.  Best of luck to you, and thanks for asking such a pertinent question!

46 years old, and I am starting to see the signs of aging. Mini Facelift? Neck Lift? Standard Facelift?

 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  From the photos there is excess fat in front of the cheeks with flat spots in the front portion of the cheeks, jowls are present and the chin is weak.  These factors combine to create a rectangularly shaped face. 

 Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler  will create full, round cheeks that will feminize the entire face.

  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 "Jowls” are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

 My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions and no incisions extend or are placed within the hair.
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

What Age is Best for a Facelift

A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift. 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. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Facelift

You would be a good candidate for a facelift with some conservative neck liposuction.  You do not need a neck lift per se, since the facelift should take care of your neckline.  

Face and Neck Lift

Your neck and lower face would benefit from lifting. The terminology can be confusing and misleading so don't get hung up on which "procedure" is the best for you. Consult with a few surgeons and use your best judgement based on the information that you receive. Maybe I'll see you soon.   :) 

Justin Yovino, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 85 reviews

Facelift Options

Thank you for reaching out and posting photos. An in person consultation with a board certified surgeon would be best, this would allow you to learn about your options as well as ask any and all questions! We would be more than happy to see you for a free consultation in our Mission Viejo or Newport Beach office. Best of luck! Dr. Kachenmeister

Robert M. Kachenmeister, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 21 reviews

Facelift or minilift

You  do have some  jowling and some laxity in the neck area.  In order to treat this adequately and give the most long-lasting results  you would need a " facelift " .  This is a  deep plane procedure which would support the underlying structures and not just the skin.    I do agree that a mini lift would not address the neck.

David F. LaPatka, MD
Santa Barbara Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Full facelift

Although its important to get a personal consultation, it looks as if you would benefit from a full facelift with attention to the neck.  I do not think a mini lift will produce the results which you desire.  

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

Facelift options for younger patients

Although there are situations where a mini lift is an option, I think in your case you will get the best, most natural, and long lasting results with a full facelift. This would include the SMAS layer.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 48 reviews

Early facial aging and what kind of lift?

You need a full facelift to get the best results since you have excess skin and fat in both the face and neck. See a very experienced facelift surgeon who does natural work!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 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.