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

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.