43, which procedures will create a more youthful appearance? (Photo)

Question

Hi, I would greatly appreciate the expert opinions here on which surgical procedure/procedures to undergo in order to achieve the more youthful look i am after. My main areas of concern are pronounced nasolabial folds and the start of sagging/jowls. I feel this is more pronounced as i have a reasonably long, narrow face. My other area of concern is my brow, which tends to now sit very heavy on my upper eyelids when I have botox. Having had an online consultation with a UK surgeon , he told me my forehead is too high to have an endoscopic brow lift, and that a traditional brow lift with possible hairline lowering may work best in combination with a deep plane facelift to tackle the vertical ageing in my lower face. My nonsurgical practitioner feels that a deep plane facelift is too drastic for my face and that a brow lift with fat transfer to my temples would be my best option, as I have some hollowing at the temples. Overall I feel very confused. I really want to lift my brow to decrease the drooping on my upper eyelids and try to achieve a lifted and refreshed appearance in my lower face and jaw but am just uncertain how drastic of a process this needs to be. I am very decided and happy to undergo surgery but want to invest my money in the right procedures to give lasting results. I am 43 and have previously had Botox and some filler in my lips and cheeks. Many thanks for any help and advice .

Henry Daniel Sandel IV, MD, FACS · Answer

**Brow and Eyelid Evaluation, With a Tailored Approach to the Lower Face**

Thank you for explaining your concerns so clearly. The differing recommendations can be confusing, but they address separate issues: brow position, eyelid skin, loss of volume, and lower-face sagging.

For your upper eyelids, the key is determining how much heaviness comes from the brow versus excess eyelid skin. Upper blepharoplasty removes excess skin but does not lift the brow. A brow lift, sometimes combined with conservative eyelid surgery, may be appropriate depending on the examination.

A high forehead influences the choice of brow-lift technique; it does not automatically rule out every endoscopic approach. A lift through an incision at the hairline may be worth discussing because it can elevate the brow while maintaining or reducing forehead height. The tradeoff includes a scar along the hairline. Your surgeon should also review your Botox placement and timing, since you notice increased heaviness after treatment.  Botox should lift your brows nicely.. and not make you feel heavy.

For the lower face, age 43 alone does not determine whether a facelift is appropriate or “too drastic.” The decision depends on the degree of tissue descent, skin laxity, and your goals. A facelift can improve jowling and soften nasolabial folds, although it will not necessarily eliminate those folds. Fat transfer can address temple hollowing, but it serves a different purpose from lifting descended lower-face tissues.

Your photograph does not show enough of the lower face and neck to recommend a particular facelift technique. An in-person consultation with a qualified facial plastic surgeon would help establish which changes each procedure can realistically achieve. The aim should be a proportionate, refreshed result with a clear understanding of the scars, recovery, and risks.

43, which procedures will create a more youthful appearance? (Photo)

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