Is my face sagging or lacking volume? (Photo)

Question

I've consulted a few plastic surgeons and got different opinions about improving my midface. One says I lack volume, and fillers or fat transfer would be best. Another thinks that I have enough volume, but the problem is tissue sagging. He reccomends a midface lift. I'd be grateful for some advice as I don't feel like adding even more volume to my cheeks. On the other hand, a midface lift (endoscopic) seems to have few positive reviews. I'm in my mid-30s.

Mats Hagstrom, MD (license on probation) · Answer

Treatment options for midlife facial aging are bountiful and different providers may have different opinions.
It’s not the procedure that’s as important as who does it.
Obviously with fillers you’ll have to repeat every six months to maintain the results.
In the end the most important variable is choosing the most talented and experienced provider. This may in fact be less important than what treatment they choose.
Doing the treatment well and having a clear understanding of the underlying problem or making an accurate assessment is what’s most important.
Personally I recommend patients start with a minimum of five consultations to find the most talented and experienced provider. During each consultation ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in or they are recommending. Simply seeing a handful of pre-selected pictures which most likely represent the best results of their career is insufficient to get a clear understanding of what the average results look like. Do you want an experienced provider and experienced provider should have a lot of before and after pictures. I would say an experienced provider should be able to show you at least 50 sets of before and after pictures for the procedure they’re recommending. 
Ask the provider to show as many pictures as possible of patients with similar body characteristics or in your case facial characteristics to your own. Ask them to show you examples of excellent outcomes, average outcomes and less than outcomes.
With all cosmetic procedures there is a substantial variance in skill and experience level among different providers in the key is always to find the most talented provider.
Continue having consultations until you feel quite certain you found the provider who’s going to service your needs best. I recommend staying with board-certified plastic surgeons.Either of the treatment options can give a good results.
The question is who is the more talented provider and going to deliver the results you’ll be most happy with.
You may not have found that person yet.
I cannot emphasize enough the importance of properly vetting plastic surgeons during in person consultations and that finding the most talented provider takes substantial time and effort and it needs to include in person consultations at which time providers need to be pushed to open up their portfolios and start being transparent.
Best,
Mats Hagstrom MD

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