Hello! I am a 43 year old actress. I am also divorced and interested in someone who is in his mid 30's (scandalous!) Here are three photos of me with no makeup, just eyelash extensions. (yuuuuck) Anyway, the things that bother me the most at this point are around my mouth area (sagging) and my neck area (sagging) I would like to get surgery this summer. Initially, I just wanted a face lift, surgeons have recommend more. (even a nose job) What would your opinions be? Thank you so much!!
What Do You Recommend for Facelift/necklift? (photo)
Doctor Answers 27
thanks for posting up your photos for comment.
If you were my patient and wanted a fresher look I would concentrate on the lower third of your face as you point out. You have a nice brow position and beautiful eyes but the early jowling and loose skin under your chin betray your years!
Any facelift that tightens SMAS and excises the excess skin in a conservative and natural way would be of benefit to you. Non surgically thermage may have a place in defining your jawline better.
No comment on your nose! It would not be high up the wishlist for surgery if it were mine!
I would be very careful about rushing into surgery just now.
Surgery has been the demise of many acting careers. Remember the symbol of beauty on Rodeo drive is a metal torso with no limbs or head. I think the artist captured something here. One wants to improve the "brand" not wreck it with over done work that leaves on looking "altered" or inauthentic. Microdroplet Botox at the brow would soften your eyebrow pinch without the frozen look. Botox can also be used to improve your mild neck cords. Subtle fill in the under eye and peri-oral area can take 10 years off your face. Having facial fill is an art form. Choose a doctor with natural results who performs these services him or herself. Also, it is very helpful to see someone who practices close to home in case your filler treatment needs adjusting. Avoid medicines and herbal products that can increase of bruising from one of these services.
Facial rejuvenation may include both volume replacement as well as surgery
Thank you for your courage in appearing au naturelle! The profiles appear to demonstrate asymmetry with greater volume deficit (fat loss) originating from the tear troughs, clefting the midface and extending inferiorly to the mandibular jowl. Comparing the marionette's lines, the left is deeper and longer, so this is where judicious volume replacement, either by structural fat grafting or dermal fillers would be essential. Given your "youth", you should consider investigate Ulthera followed by volume replacement. On the other hand, if you "hate" your neck, choose a lower facelift & necklift with fat grafting. The features of your nose are a "boxy" (square) tip and dorsal hump (slight bump). I would advise ranking your "dislikes" and addressing those, which most concern you, rather than committing to a complete makeover, especially since you are an actor!
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Volume enhancement first for facial aging, maybe a facelift that preserves your facial character. Caution with rhinoplasty
I wrote a book years ago called “The Fine Art of Looking Younger” where I discuss things that happen when one gets older: we lose volume, have skin elasticity changes, and the skin and the SMAS (superficial muculoaponeurotic system) which is the support structure under the face gets loose.
As a person ages, the cheeks may get more hollow and this sometimes makes the nose look more prominent. A procedure like volume enhancement may be worth considering. However, as a surgeon, I don’t just jump into a procedure such as rhinoplasty to address facial aging. I advise that you do not let surgeons push you into doing something you are not prepared to do. In my opinion, rhinoplasty can change your overall facial characteristics.
My approach would be to do a facelift that would fill and give the right volume to the face in the right places. I make sure that the results of the facelift procedure don’t separate your character with your facial appearance. Your family members as well as your friends still recognize you and at the same time, you look younger. A procedure that balances your face should be the aim in terms of getting a fresh look. I hope that was helpful, and thank you for your question.
Facial rejuvination in a 43 year old
Thanks for including your photos. I think you would be a good candidate for a short incision face lift. This would allow tightening of the jowl, jawline and neck. The scars heal very well and are hidden around the ear and hairline. If you feel your nose would benefit from reshaping then that is something that can be done. The two procedures in combination would certainly give you a very nice "refresh". Attached here is a video about the short incision facelift.
Short Scar facelift with Rhinoplasty
Upon reviewing your photos and concerns, I would recommend a short-scar facelift to correct your issues with some fat grafting to add structural support. You have mild jowling and neck laxity which would easily be addressed with a vertical incision facelift (short-scar). There would be no incision behind the ear and the incision in front of the ear would be retro-tragal, meaning it would go inside the ear instead of pre-auricular which is in front. You would be able to address the deeper foundation of the face, the SMAS, to correct the jowling and also remove some loose skin. Concerning the nose, you have a bulbous tip with a small dorsal hump and lack of projection. I would do an open rhinoplasty to give more tip definition and increase projection and remove the small dorsal hump.
Face lift evaluation
I would hold off a facelift! I think a visit for non-surgical rejuvenation is a more reasonable approach at your age. A strong consideration needs to be natural volume enhancement like Sculptra and some skin tightening (also non-surgical) such as a laser peel, Ulthera in combination with Photofacial treatments and of course... Botox! It works great! The nose is not a bad idea at all- it would refine your nasal tip and would add to your facial rejuvenation. Best Wishes!!
What do you recommend for a facelift/neck lift?
At 43, you are still young and it may not yet be time for a full facelift. In general, the types of facelifts and their target areas are as follow:
1) Traditional facelift: a great option for a patient with more advanced signs of aging who wants to refresh their neck, jawline, and cheeks.
2) Mini facelift: A less invasive facelift that rejuvenates the lower third of the face, including the jowls and neck.
There are also a variety of additional procedures that can be used in conjunction with a facelift or mini facelift to achieve optimal results. These options include but are not limited to:
1) Liposuction of the jowl or neck
2) Fat transfer to the face
3) Cheek implants
It looks like you may be a candidate for a mini facelift, but only an exam can tell for sure. If you wish, a rhinoplasty can be performed to enhance the appearance of your nose. But this is a personal decision, and can be discussed during an in-person consult. I hope this helps, and I wish you the best of luck.
Volume restoration is often helpful as well
I agree with a lower face and neck lift. This will help with the jowls as well as make a nice difference in the neck. This can be done in a way that redefines and rejuvenates the lower third of the face and will still look very natural. The one area however that is often overlooked is the what we call the midface area. Basically the midface is the area below the eyes and the nasolabial fold. I often will perform a fat grafting procedure at the same time to add some volume to that area. The amount of volume added does not need to be excessive to achieve a great result and improvement. The best way to see what this would look like is to take a look at picture of yourself from 10 years ago. The additional fullness provided by the fat grafting can restore that more youthful contour.
Early Aging- What To Do?
Your photos show the typical signs of early aging. You have sagging of your cheek tissue, left greater than right, with deepening of the nasolabial folds, marionette lines and early jowling. I would recommend a standard midface lift with attention to the jawline and neck skin. I would also consider some fat grafting to the cheeks, perioral area and lips. For a drastic change a rhinoplasty and browlift may be indicated but only if you really want to change the way you look to others. A small chin implant would complete the transformation.
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.