Facelift and breast augmentation on 66 year-old woman. Suggestions? (Photos)

Based on your goals and current anatomy, a breast lift (mastopexy) would be an ideal solution to restore a more youthful and lifted appearance. Depending on the volume you wish to achieve, we can also consider placing implants; however, your existing breast tissue may already be sufficient to give you the desired shape without the need for implants. This will be carefully evaluated during your consultation.
Additionally, considering facial aging and the natural downward pull of gravity on the tissues over time, a facelift would be a strong option for you. This procedure repositions the deeper facial structures opposite to the direction of gravity, which not only provides a natural lift but can also restore a more youthful contour. Patients often see a rejuvenation effect of 15–20 years, depending on their skin condition and facial structure. Our approach always prioritizes a natural-looking result. The goal is to help you look like a refreshed, younger version of yourself .

Great questions! Based on your photos (and of course depending on examination), a revision facelift is appropriate. I would also advise the addition of fat transfer to your face to restore lost volume and structure, especially to your cheeks, temples, nasolabial folds, and marionette lines. Also would consider upper and lower blepharoplasty and lip lift if those are areas that bother you. For your breasts, given your activity and weight lifting, a subfascial augmentation is definitely worth considering--this is great for subtle volume and upper pole fullness in active women, especially with a low or moderate profile implant.

First of all, you don't appear to be in your 60's at all! You're looking great. To maintain graceful aging, you might consider a revision lower facelift to reposition the tissues back to where they used to be–lifting the cheek mound and refining the jawline/jowls will make a huge difference. I also highly suggest fat grafting with your facelift to restore the loss of volume. Particularly, fat grafted to the temples, mid-cheek, nasolabial folds and jowl area. For the breasts, the best option for upper-pole fullness is an implant. You could consider a lower profile implant to avoid too much projection. However, because your breasts are naturally large, it will be important to consider that the implant size itself would need to be on the higher size in order to fill out your natural breast envelope.

Thank you for your thoughtful question, and for sharing your journey so far. It’s great to hear that you're in excellent health and leading an active lifestyle—that certainly works in your favour when considering facial and body rejuvenation procedures.

As a facial plastic surgeon, I’ll focus on the facial aspect of your inquiry.

Since your previous facelift was nine years ago, it’s very normal to notice some recurrence of skin laxity due to the natural aging process. What would be helpful to know is the type of facelift you previously underwent—particularly whether it involved deep plane lifting or was more superficial (e.g., skin-only or SMAS plication). This can impact both the longevity and quality of the initial results, and guide recommendations moving forward.

Based on your age, the time since your last procedure, and the desire for a refreshed yet natural look, I would recommend a deep plane facelift and neck lift, which addresses not just the skin but also the deeper facial structures. This provides more comprehensive and longer-lasting results. Additionally, combining it with a keyhole (endoscopic) brow lift, upper and lower blepharoplasty, lip lift, and facial fat grafting could achieve full facial rejuvenation—targeting volume loss, sagging, and skin texture in a harmonious way.

I would recommend an augmentation-mastopexy. This can be done at the same time of facelift/necklift. I recommend keeping general anesthesia under 8 hours total to reduce the risk of potentially increasing perioperative complications.

I believe from what I see in your pictures that you would benefit from a deep plane facelift. Your facial structures have dropped and need to be fixed to the appropriate location. The skin will not hold if this is not done appropriately.An appropriately sized implant placed subglandular will give you the appropriate fullness of the breast without creating excess upper pole fullness. Hope this helps.

Your facelift nine years ago has served you well, but as you mentioned, the effects of aging are ongoing. A secondary facelift (revision facelift) is a very reasonable consideration at this point—especially if you're looking to regain that refreshed, lifted look. With modern techniques like the deep plane facelift, we can achieve more long-lasting and natural results by addressing deeper facial layers and not just the skin.
Regarding breast augmentation: Being 66, healthy, with low BMI, and active, you're actually a great candidate. The key is choosing the right implant that fits your body naturally and doesn't create an overdone or “too high” appearance. For patients your age, we often recommend anatomical (teardrop-shaped) or low-profile implants to add fullness to the upper pole while maintaining a subtle, age-appropriate silhouette.
Natural harmony and proportion are always the priority.

Based on what I can see from the photos, you appear to be a good candidate for both facelift revision and breast lift surgery. However, a thorough physical examination is absolutely necessary for a complete and accurate assessment.
For your face, a revision facelift could be performed first. With aging, gravity and changes in skin quality can lead to sagging, even after a previous facelift. In such cases, a secondary procedure can be highly effective. In healthy patients like yourself—with a low BMI and a consistent exercise routine—a deeper technique such as the deep plane facelift is often recommended. This technique goes beyond the superficial layers and repositions the deeper structures, including the SMAS layer beneath the facial muscles. It provides more natural, longer-lasting results, especially in the midface, cheeks, and jawline, creating a refreshed appearance without the pulled look.
As for your breasts, I believe a breast lift (mastopexy) would be the primary approach. During an in-person evaluation, we would assess breast tissue, skin elasticity, and nipple position. If there is adequate natural tissue, a lift alone may provide a satisfying result. However, since you mentioned wanting more upper pole fullness, augmentation with implants can be added if you're a suitable candidate. Implant choice should be tailored to your body type, skin quality, and aesthetic goals—typically favoring a natural shape and proportion that harmonizes with your figure.I would recommend Motiva ergonomix series for a natural result . When done thoughtfully, the result can look beautifully balanced and far from artificial, even at age 66.

Yes, breast implants will give you the upper pole volume you want. However, you should consider a vertical breast lift to correct the lower pole excess. Must be vertical, not an inverted-T (anchor scar). I see you have had a previous lift. Your surgeon needs to be careful not to elevate your nipples because they are already sitting high. Have you considered facial fat injection? You are a good candidate.

For your face a deep plane face lift may improve longevity of results. I would also consider a lateral brow lift and upper and lower lid blepharoplasty. For your breasts, I think you have sufficient volume so a mastopexy or lift would be nice without excessive enlargement.