47 looking old resting b*tch face. How can I improve my features? (Photo)

Question

Hi I’m 47 and my face is sagging extremely badly I look miserable all the time, I’ve noticed my features are larger than they use to be and I have no jaw line, I lost weight but my face hasn’t improved it looks clumpy and heavy at the bottom of my face, my nose has widened at the tip, my philtrum has lengthened and my cheeks are flat after having a youthful look right up until a year ago, I’m being checked for thyroid issues and acromegaly as my forehead and brow look bigger, nose is larger

Bora Ok, MD · Answer

Hi from Istanbul, thanks for your question. Over the years, especially with weight fluctuations, sagging in facial tissues can occur, which is a natural event everyone experiences. First, I recommend maintaining a healthy weight range. A facelift can correct sagging in the jowl and cheek areas by repositioning tissues. Additionally, a temporal lift can enhance the upper face and brow area by creating a more rested, softer look. Combining rhinoplasty with a lip lift can create a more refined mid-face. I suggest a facelift, brow lift, and lip lift for the first surgery, and rhinoplasty for the second surgery for best results. Hope this helps, best of luck!

Jill Hessler, MD · Answer

It is best to seek medical attention with a primary care physician if you notice significant changes to facial skeleton rapidly to assess if there are any treatable medical problems. I see many patients after significant weight loss and drooping and a heavy lower face is a common concern. A deep plane facelift can correct many of these changes and recreate the 'triangle of youth' with a wider cheek and mid face area narrowing down to the jaw.

Arif Eroglu, MD · Answer

Hello; As we are getting age, the cheek; becomes rounder and wider. Nose; falls down and becomes plump. Cheeks; it loosens and goes down. The line between the cheek and neck; becomes fainter. This; if weight loss is added, sagging occurs; will increase for much further. Because, the volume of the superficial fat compartment; decreases. Lifting for the cheeks up; in order to look more vibrant and younger; Endoscopic Midface Lift or Deep Facelift; can be implemented. Thus, the cheek tissues and chin corners which are falling down; it can be pulled up for providing malar area fullness and jawline clarity. For vertical lengthening of the upper lip; I recommend for Liplift procedure.

Ryan Rebowe, MD · Answer

It is common after weight loss to feel some sagging of the skin of the face or having an older appearance. Typically, a face and neck lift will be able to tighten the skin of the lateral face. In order to better correct for a more youthful appearance, fat grafting to the cheeks and midface will often be performed. Upper face surgery, including an upper and lower lid blepharoplasty and brow lift, can also help. These procedures can be done all at the same time or separated depending on both surgeon and patient preference.

Ajaya Kashyap, MD · Answer

Thank you for your query. You have some descent of  facial tissues along with the fat pockets and  some skin laxity. A face and neck lift with some autologous fat injections will give you great results. The nose can be refined as well. You should, of course, have all endocrine issues ruled first. Please find an experienced board certified Plastic surgeon who can help you with all your concerns. All the best

John Reilly, MD, FACS · Answer

Hello,

I will divide the face into three sections those being the eyes and forehead, the central part of the face including the nose and cheeks and the lower third of the face including the mouth and jowls. Your brow position is good, forehead has minimal wrinkles and upper lid skin excess. with minor asymmetry.  The middle portion of the face, as you point out, has a round or boxy tip of the nose. A rhinoplasty can help define the tip but it is a bit more difficult with thicker skin. You have had some flattening in the area of the cheek under the eye and that can be treated with fat grafting or filler. The area known as the nasolabial fold which is the crease that begins at the bottom of the nose and goes down towards the side of the mouth can also be filled with fat or fillers. In addition, the areas below the lower lip towards the sides can also be filled. Filling these areas helps reduce the discrepancy between the flat area and a fuller area to the side. This will help reduce shadowing of light and make that area of skin appear lighter and not stand out. Same principle for the nasolabial folds.

Fat grafting can be done in the office with local anesthesia. The benefit of using your own fat is that the fat that "takes" will last forever whereas the use of  fillers is a more straightforward, simple process but needs to be repeated yearly. 
Good luck.

Gary M. Horndeski, MD · Answer

I recommend a facelift and browlift.  After this has been completed, I would then recommend a rhinoplasty and lip lift.

Best Wishes,

Gary Horndeski, M.D.

Jeffrey M. Darrow, MD · Answer

First,  it would be important to have your primary care doctor perform a thorough evaluation to be sure your overall health is good.  Then you should consult with a board certified plastic surgeon to address your concerns.  A facelift/necklift would create a more defined and straight jawline as well as create fill in your cheeks which will improve the flattening you notice.  Increasing your cheek volume and defining your jawline will improve the heaviness in your lower face.  A tip rhinoplasty can reshape your nasal tip to refine its contour and a lip lift can shorten your upper lip toward a more youthful length and shape.  These procedures can all be accomplished at one sitting so that you have one recovery. You should have a detailed consultation with your plastic surgeon to discuss these options. Best wishes.

Mats Hagstrom, MD (license on probation) · Answer

I think a good medical work up is appropriate as you described.
To make a good assessment, we probably need to see series of picture overtime to see how your face has changed.
Most facialist statics is primarily determined by facial skeletal bone structure.
If your bone structure has indeed changed, then it would be important to know why and also to take into consideration the best course of action in regarding treatment options.
Your situation is far too complex to give you a quick answer based on an online post.
I do think you should contact cranial facial surgeons in your community to get a formal assessment and have a good understanding of all treatment options, including the most involved procedures.
From there on whatever you choose to do you’ll at least have a good understanding of all the treatment options.
If you start with the simplest soft tissue solutionsthen you are likely to be left dissatisfied.
Simplistic, soft tissue solutions to treat problems based on facial skeletal structure, often leads to less than ideal outcomes.
Once your medical work up is complete my best suggestion is to spend significant effort on finding the best providers before even contemplating having surgical intervention.
Consider talking to surgeons from both plastic surgery and oral surgery backgrounds.
The biggest challenge is probably going to be finding the right providers for you.
This is often the case.
Even if surgical treatments are limited, it is always ideal to be working with people who have sufficient skill and experience to understand what can and cannot be accomplished.
Deciding how far you want to go with this should be based on having an in-depth understanding and this may require having numerous consultations.
Best,
Mats Hagstrom MD

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