A Facelift at 36? Will Fillers Make My Face Sag? (photo)

I'm 36 and noticed some cheek sag earlier in the year so began facial exercises. I have since lost 10lbs and the sag is much more noticeable and extends to the jowl area. I have been advised by one surgeon that I am a little young but I am unsure. My mother had a facelift at 50 but she needed one many years before and therefore the results aren't as good as they could have been. I have seen filler recommended but will these lift sag? My face doesn't look gaunt and I have always had 'big' cheeks.

Doctor Answers 12

The young person's facelift...

Facelifts for people under 45 is a difficult dilemma.  I agree with the others in the sense that you will see some improvement with fat injections (and perhaps other temporary filler injections) along your tear troughs and nasolabial folds and marionette lines.  However, there may be a fundamental, genetic tendency for loose skin and saggy facial fat in certain individuals at a younger age.  These are components of aging and replacing volume is a good initial thought.  However, the loose, inelastic skin is sometimes difficult to overcome.  In these individuals, a facelift or mini-facelift may be just the thing to restore the tight appearance of youthful skin.  This may also be done in conjunction with fat grafting.  I don't think there should be a stigma placed on facelifts for younger individuals.  There is nothing to preclude you from repeating the facelift 15 or 20 years later if desired to maintain that youthful appearance.  


I believe that going with fat injection first to see it's effect is not a bad way to go.  If you're unhappy, there is always the option of the facelift which can be safe and relatively simple.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 4 reviews

Facelift at age 36

Chronological age does not always correspond to age appearance.  Certainly, weight loss can result in sagging of facial and neck skin, especially if there is a genetic tendency toward this.  That being said, I would suggest you get to a weight that you can easily maintain, then see at least 3 surgeons with experience in this type of surgery in younger people.

Michael Leff, MD (retired)
Bellevue Plastic Surgeon
5.0 out of 5 stars 10 reviews

There may be a much easier solution.

Review of your photos seems to indicate that you have an overbite with retrognathia.  This means that your jawbone is positioned behind where it should ideally be for the amount of overlying tissues.  It leads to the early appearance of jowls and the cheeks will often look "relatively" larger.

We get great results in patients like you by using an extended "chin-jowl" implant and submental liposuction to allow the tissues to repostion themselves.

Fillers can always be added later, but some patients will not need them.

Dr. Mayl

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon
4.3 out of 5 stars 7 reviews

Fillers are the way to go here.

At 36 you do not need a facelift!  That does not mean that someone out there wouldn't agree to perform such a surgery.  The fillers are helpful because you can have multiple areas addressed in a way not possible with surgery.  Using fat instead of fillers?  This is certainly more profitable for the surgeon because it entails surgery rather than the use of expensive filler materials.  However, you need very precise treatment to achieve the best result.  This is difficult to accomplish with fat.  The most important thing is to find a very experienced injector to perform your treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

The Treatment of Premature Aging at 36

One of the most common causes of premature aging is weight gain followed by rapid weight loss. The photos show many of the classic signs of facial aging includingthe olwer eyelid "V" deformity, descent of the malar fat pad, deepening of the nasolabial folds, the beginning of marionette lines and the loss of jawline contour particularly on the left side. Artificial fillers may help to camouflage some of these problems while fat grafting may provide a more natural and longlasting improvement. Fillers will not lift the descended tissue off the jawline nor will liposuction of the fat "bubble" improve the jawline. Many surgeons offer an abreviated midface lift that addresses the jawline in particular. This minor procedure with incisions around the earlobe with adjuvent fat grarting is the best option for premature aging.

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon
5.0 out of 5 stars 7 reviews

A Facelift at 36? Will Fillers Make My Face Sag?

A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift. During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 107 reviews

Mini Facelift Plus Fillers May Help Early Facial Aging

Thank you for submitting your question and photographs. You are young looking with very nice normal unblemished skin.

A mini facelift in a person your age can reduce laxity in the jawline, neck and cheek area and can be of benefit.

From your photographs it appears that the right side of your face is fuller in the cheek area than is the left side. Asymmetry like this is very common in the human face and most all people have some form of asymmetry.

However I would consider using soft tissue fillers especially in the mid face cheek region in addition to a mini lift to bring the face into better balance and symmetry.

Fillers When Properly Injected do not make your face sag

Despite being young you do have jowl formation which may be hereditary and you would do well with a mini-facelift like a LiteLift or MACS procedure. In general face exercises do NOT help keep the face looking younger and in some instances will accelerate the wrinkling process. You may also have a weak chin (microgenia) which could be corrected with a small chin implant but evaluation with your chin not pointing down is needed to determine this.

Here is a primer on how your face ages and why one or more approach is required for the best result: Please note that you age by three factors - sagging (through gravity and time), loss of volume (counteracted by fillers), and skin texture (determined by environmental and genetic factors). Your fillers should enhance your effect of the lifting if placed appropriately by addressing one of the causes of aging..Most often one of these factors are more out of balance than another and therefore your procedures should customize for what is most needed. Often fillers alone can "stall" the inevitable as they only correct one aspect of aging.

Facelift and Skin resurfacing procedures (laser, Ulthera or Thermage ) and fillers are synergistic so as long as you wait until the Sculptra injection site is soft you should do fine. Not a problem and there is no problem with the timing for a facelift. Sculptra, Radiesse, Jeuvederm, Restylane, your own fat (fat transfer) and other fillers address volume issues, resurfacing procedures corrects surface flaws associated with aging and face lifting addresses the sagging loose skin. Resurfacing procedures address skin texture, color variation (e.g. sun spots)- so all three are synergistic and complementary. It is very common in my practice to do all three approaches to rejuvenation at the same time


Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Am I too young for a facelift?

It is relatively uncommon that a 36 year old experiences the type and degree of aging that would require a facelift to fix. A facelift is effective at addressing jowling and laxity in the neck and creating a nicely defined jawline. From the pictures that you have provided I don't see howling and I can't get a good assessment of your neck. You do have some atrophy of the cheek fat which has created some hollowness. You also seem to have a slightly retrusive chin with fullness in the neck underneath the chin. I would consider fillers in the cheek, nasolabial fold, and tear trough as well as lipocontouring of the neck and a possible chin implant. I would visit with at least two qualified and experienced surgeons and get a comprehensive analysis. Good luck!

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Matter of Architecture

One of the challenges we face is that of patient expectation and a decision about facial rejuvenation timing. It is not a numerical decision, "I am 36 and I can't need a facelift yet!" It is actually a matter of architecture of your face combined with the texture changes of your skin.  The photos depicted are of course, not the same as an evaluation in person.  If jowling is of concern that a series of Sciton laser Skin Tyte treatments, once a week for six weeks will be of great benefit.  This non-operative infrared laser technology has the most benefical effects, and the more youthful the person is, the better the skin tightening phenomenon.

If your main concern is some flattening and volume loss around the eyes and in the mouth and marionette lines, called facial lipo-atrophy, then a marvelous improvement of volume that is the most long lasting is the use of autologous (your own) fat transfer.  This minor surgical procedure harvests fat and stem cells and allow for a high rate of "take," namely about 90% of the fat cell volume seen clinically at 3 months after transfer is seen in the 1 year and 5 year follow-up.  It would be a wonderful measure in improving the features I've seen depicted in these photos.  Other fillers have some of the benefits, but nothing beats structural fat!  The short answer is that volume has a reasonable effect of elevating the laxity seen and alleviating most of the midface and lower facial laxity.  The younger and more elastic the better.  But will it be enough to satisfy your goals? That requires our careful discussion not appropriate for this forum. 

That leaves the decision about taking the loose skin and marionette lines and having a mini-face lift effect easily seen when you pull your face in the mirror each morning and night at your bathroom mirror.  There is no substitute for asking you if that makes you happy.  If it does, then simply acknowledge that the cards you have been dealt (vis a vis your mother's heritage is manifesting in you) will give you a better look and make you feel great when you look in the mirror if you have a facial rejuvenation! A mini face lift will solve most or all of the problems you've identified, the ones I have enumerated and won't leave you guessing about the outcome while you heal.

Of course this answer doesn't have the benefit of seeing you or discussing your particular circumstances that allow me to make other recommendations that fit your goals, recovery needs and budget.  That is what the consultation process is for, to tailor your goals in the context of my expertise.

Paul Vanek, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.