58 year old black woman with frown lines, laugh lines and jowls. What is my best treatment option? Do I need a full facelift?

Question

I am a 58 year old black woman. I lost about 5st in weight through stress then OMAD. Now I have forehead frown lines, deep laugh lines and jowls. I have done so much research and no help at all for black people.Can Dr advise me honestly please as to what I should do I need a full face lift. I fancy fast and now Botox and dermal fillers, but I am afraid through my research. Please guide me to the best procedure.

Semih Yildiz, MD, FEPOBRAS · Answer

Without photos or an in-person exam, I cannot say whether you need a full facelift, but your description sounds like more than one issue. Botox can soften active frown lines and forehead movement lines. Dermal fillers can sometimes soften smile lines or restore selected areas of volume. However, fillers and Botox do not truly lift jowls or remove loose lower-face and neck skin.

After a large weight loss, jowls, loose skin, and deeper folds are often better treated with a surgical lifting procedure if the laxity is significant. That may mean a lower facelift, neck lift, or combined face and neck lift, depending on your exam. A well-planned facelift should not make you look pulled or different; the goal is to reposition sagging tissue and reduce excess skin while keeping your natural facial character.

For darker skin, these procedures can be done safely, but you should choose a surgeon who has experience with skin of color. Important points include careful incision placement around the ear and hairline, asking about your personal or family history of keloids or thick scars, and being cautious with aggressive lasers or heat devices that may increase the risk of hyperpigmentation.

If you are unsure, start with a conservative consultation rather than jumping into treatment. Ask the surgeon to separate your concerns into three categories: muscle lines, volume loss, and true tissue laxity. If the main problem is jowling and loose skin from weight loss, repeated filler may become expensive and heavy-looking, while surgery may be the more effective foundation. Also make sure your weight and nutrition are stable before any elective surgery, since recent major weight loss and stress can affect healing.

Jill Hessler, MD · Answer

I would recommend you consult with a facial plastic surgeon that is experiences in minimally invasive and surgical treatments. In general, frown lines and upper facial lines are best treated with Botox or similar neuromodulator and the jowls are best treated with a facelift.

Safa Manav, MD, FEBOPRAS · Answer

At 58, with concerns about forehead frown lines, deep laugh lines, and jowls, a full facelift might provide the most comprehensive and long-lasting solution. However, non-surgical options like Botox and dermal fillers can also effectively address these issues with less risk and downtime. Botox can smooth frown lines, while dermal fillers can reduce laugh lines and restore volume to the cheeks, diminishing the appearance of jowls. Consulting with a board-certified plastic surgeon or dermatologist experienced in treating diverse skin types can help determine the best approach tailored to your specific needs and concerns. They can provide an honest assessment and guide you through the potential benefits and risks of each option.

Ryan Rebowe, MD · Answer

For the issues you are describing, it sounds like a full facelift would be the best thing to help you achieve your goals, especially after weight loss. Many times, fat harvested from other areas of the body can be grafted to the face to restore lost volume. For the forehead lines, this may be best treated with a brow lift procedure. Facial cosmetic procedures are usually combined in very specific ways depending on your specific goals, and an in person physical exam with a board-certified plastic surgeon will be the best way to tell what you may be a candidate for.

Stephen Prendiville, MD · Answer

Significant weight loss at age 58 will lead to skin laxity that will require surgical intervention for facial rejuvenation.  Without photos, it's hard to give recommendations, but most likely you will require a deep plane facelift to address the cheeks, jawline, and neck.  A brow lift will soften brow expression but will not remove forehead lines or motion entirely.

John Michael Thomassen, MD · Answer

A facelift and possibly a brow lift are the best options for the issues you mentioned.  With proper care to avoid scar tension you can get a great result without concerns for hypertrophic scars.

Alan Gonzalez, MD, FACS · Answer

Hi @Energetic938286, thank you for your question. Surgical facial rejuvenation can improve sagging in the second and third thirds of the face, being a more radical and long-lasting solution. The goal is to restore facial volume in areas such as the cheeks, eliminate sagging along the jawline and create a smoother appearance with fewer visible wrinkles. Age 58 is an ideal age to make this change.

Additionally you can complement this surgery with non-surgical treatments such as ultrasound and radiofrequencies that stimulate elastin and collagen, as well as botox and hyaluronic acid; so that you have results that last and are maintained over the years.  For more information and recommendations, it is prudent to consult with one or more board certified plastic surgeons. Best regards!

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear energetic,

Congratulations on your 70 pound (five stone) weight loss. There is not much literature, recommendations, and/or outcomes for people of color desire, and/or require a facelift. I suspect with a five stone weight loss you have significant deflation of your face. Botox and fillers will be minimal help in my opinion. Certainly with loss of volume and laxity of your facial skin. You should be a good candidate for a full facelift. The caveat for people of color is, do they or will they form keloids. If this is a known problem, then pressing forward, the discussion of surgical incisions on the face should be immediately halted. I would try to seek out surgeons who have experience with your unique concerns.
Hope this was helpful.

Best wishes

Stephenson, Junior, MD, DDS, MBA
ESJ Aesthetics,
#TruthAndTransformation.

Donald B. Yoo, MD, FACS · Answer

Forehead frown lines are best treated with a neuromodulator such as Botox or Dysport. They will relax the muscles of facial expression responsible for creating those wrinkles. Smile lines and laugh lines may respond to facial fillers such as Restylane or Juvederm, depending on the depth and severity. Jowling may respond to energy based skin-tightening devices such as Ulthera, Potenza or Oligio X, but when more significant may require a facelift.

Mats Hagstrom, MD (license on probation) · Answer

If you haven’t done so already, I suggest scheduling multiple in person consultations with plastic surgeons in your community who seem to have extensive experience with facelift surgery.
Without including pictures, we can’t begin to make an assessment.
There are a number of variables to take in the consideration.
 Generally speaking facial aesthetics have a lot to do with facial skeletal structure.
This includes some of the reasons some people show more premature facial, aging than others.
FAA lift may or may not be an appropriate option for you.
Facelift surgery may or may not cause issues with visible scars in individuals who are prone to excessive scar formation, which you may or may not be.
Personally, usually go over with each individual person before doing any surgery.
I ask my patience to show me areas where they’ve had previous surgery or injuries to assess what type of scar formation they are likely to form from a surgical procedure.
 Certain parts of the body and face tend to be more forgiving in terms of a scar formation, but individuals who are prone to hypertrophic scar formation may want to consider not having surgeries that have extensive scars.
Whether facelift is indicated or not, cannot be determined by verbal description.
You need to include pictures, but I suggest you just have in person consultations to get an assessment and better understanding of treatment options.
When patients do research, they usually don’t realize that there is very few sources of unbiased information in regards to Internet searches for plastic surgery.
Find the best facelift surgeons in your community and have in person consultations.
Best,
Mats Hagstrom MD

58 year old black woman with frown lines, laugh lines and jowls. What is my best treatment option? Do I need a full facelift?

Answers (11)

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