Micro facelift, filler or PDO thread - which procedure would minimize signs of aging and be best for me? (photos)

Question

I’m 34 and have always had big cheeks and a round face, but have started to notice signs of ageing around my neck, jowels, smile and marionette lines. I’ve had Botox on my forehead, a filler in my frown line, but looking for more permanent options. Am I too young for a micro facelift? What about PDO threads? O I am worried filler would just make my cheeks look bigger, but is this an option?

Alan Gonzalez, MD, FACS · Answer

Hello @luca9876, thank you for your question. A mini facelift is a cosmetic surgical procedure that can help lift and tighten sagging skin on the face, usually focusing on the lower half of the face and neck. Although mini facelifts are often used to correct signs of aging such as jowls, wrinkles and sagging skin, they are not usually recommended for people in their 30s who are experiencing premature aging. It is very possible to improve skin elasticity and define the edges of the face or jawline with a non-surgical treatment such as Ultherapy which is a non-invasive treatment that uses proven ultrasound technology to stimulate the formation of new collagen deep in the skin. This can be a non-surgical alternative. It is important to consult with a board certified plastic surgeon(s) for further information and recommendations. Best regards.

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

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

Ali Riza Öreroglu, MD · Answer

Based on what I can observe from your photos, the combination of full cheeks, a round facial shape, and early signs of aging in the lower face (such as jowls, neck laxity, and marionette lines) suggests that a deep plane facelift combined with buccal fat removal (bichectomy) could be an effective and long-lasting solution.

The deep plane facelift lifts not only the skin but also the deeper facial structures, providing a more natural and long-term improvement in sagging—especially along the jawline and neck. Bichectomy reduces midface volume by removing buccal fat, creating a more defined and feminine facial contour without relying on fillers, which you understandably prefer to avoid.

Additionally, PDO thread treatment can be considered as a less invasive alternative or complementary procedure. PDO threads are biodegradable sutures placed under the skin that create a lifting effect and stimulate collagen production, helping to tighten and rejuvenate the skin. This method can be effective for early signs of aging and mild sagging, with a shorter recovery time compared to surgery.

However, a physical examination is crucial to more accurately assess your facial anatomy, skin quality, and soft tissue dynamics. This will help determine the most suitable personalized treatment plan for you.

John Michael Thomassen, MD · Answer

A mini facelift will lift your cheeks and eliminate the lines around your mouth and fullness in the lower face.  This would be the best procedure to address your issues.

Lexie Wang, MD · Answer

Hi! Since you are looking for a more "permanent" option, then the best bet would be to go ahead and do the surgical face lift and also some fat grafting to build up volume. After that, then you can get into maintenance nonsurgical treatments. Don't do PDO threads.

Kshem Yapa, MBBChir, FRCS · Answer

Hi thanks for the interesting question and the photos.
This is a great question. My Personal feeling is that fillers and facelift whether it be called micro, mini or anything else are good at addressing two different things. Fillers are good at replacing volume which we do lose as we age whereas all facelift techniques address structural laxity in the face. So as we age our tissue become more lax and then with gravity migrate south leading to some of the changes you describe like jowls marionette lines and neck laxity. When we use fillers to camouflage changes in laxity this is when things start to look unnatural and overfilled in my opinion.
It is unlikely that when you are young that you would develop structural laxity but this is the key for me rather than a specific age . If you have structural laxity whether you are 34 or 54 then a facelift may be able to address this effectively to give a natural looking result. Looking at your photos I dont think adding volume with fillers is the answer but you do have some structural laxity. You mention round face as an issue and buccal fat reduction may be an option to slim the face but I would discourage you from doing this at a young age as we tend to lose fat from our face as we age and so surgically removing it when young doesn't make sense for most people. 
Thread lifts are not very effective long term and also make facelifting more challenging too as you find threads in the face and often in locations you wouldnt expect or at depths which you wouldnt accept.
The terms micro , mini etc when it comes to faclift are also a little meaningless as it means different things to different surgeons so I would have a long conversation with the surgeon of your choice 
Hope this helps Kshem Yapa

Gerald Minniti, MD, FACS · Answer

Despite your age, You have descent of your midface with jowling. Mini- or micro- face lifts are an old concept that hasn't stood the test of time. Any facelift expert will tell you that the younger you are, the more important proper separation of layers before pulling on is to getting a lasting result. Mini facelifts yield mini-results for a minimum amount of time, as in one year at the most. Same for threads of any material; threads are garbage that's enjoyed social media misrepresentation.

Carmina Cardenas, MD · Answer

I see more and more often premature aged patients, specially amongst who have suffered from significant weight loss, weight being unstable, excess sun exposure, bad habits. 
I truly believe it does not matter the age, it matters the aging changes on the face which dictates who is candidate or not. 
You are a perfect candidate for Deep plane mid facelift, deep plane neck lift, most likely facial fat grafting only in the needed areas and I wish I can see your eyes because I am almost certain you will need eye rejuvenation as well. 
The purpose is to make you look refreshed! Not tight. Pure beautification. 
Be encouraged and please do not do minor procedures which will lead to minor and poor results and will riun the possibility of a great surgery outcome. 
Dr. Cardenas

Kyle Kimura, MD · Answer

This is an excellent question. The biggest thing I see on your frontal view is some mild descent of your midcheek volume and mild jowling, or fullness on the sides of your jaws. In my opinion, it may be a little early for a facelift, even a mini-lift, though you would likely find some surgeons that would consider offering this. As for the threads, I would highly advise against this option as these do not have even evidence that they work longer than a few months. Filler is always a good temporary option to consider, I would actually consider doing filler a bit higher in the cheeks and under the eyes. As for the fullness of the cheeks, buccal fat excision could be a good long term option or botox injections to the masseter to see if this softens the "squareness" of the jaw some. Hope this helps and best of luck! 
Kyle Kimura, MDFacial Plastic and Reconstructive Surgery

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin. This is a great question. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117, just call and ask for Jess :) I hope this helps and best of luck!

Ronald J. Edelson, MD · Answer

I generally don’t perform facelifts on patients your age. However you have heavy jowls and may actually be a candidate for a facelift with liposuction if your jowls

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