Is Facelift Too Premature for a 45 Year Old Woman?

I'm 45 and have under eye bags and nasolabial folds that really bother me. I've gotten 3 different recommendations on what I need, ranging from lower Blepharoplasty with Juvederm for the folds, to uppper/lower bleph with a Forehead lift plus a midface deep plane facelift.

The doctor who recommended "the full monte" is highly regarded and his work is outstanding, but I don't think my face is that bad "yet," and I'm wondering whether I should do everything now or only the most urgent items. A Facelift seems premature to me. Looking for opinions/recommendations. Thanks!

Doctor Answers 52

Surgery or Not at 45?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your question is a good one because many women of your age group ask the same question. How do we measure the right time for a Facelift, by chronology or by aging changes?

From looking at your pictures, you do have the aging changes that would benefit from a Facelift, and Lower Lid Blepharoplasty. However, you may not want to consider surgery and it is not unreasonable to consider fillers and Botox. The important point to understand with the minimally invasive route is that you will not receive the same results as you would with surgery. You should weigh what results you want with the cost and downtime associated with surgery. Are you a surgical candidate (assuming good health)? Yes. Are you prepared for it? You must decide.

Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Right age for Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Without giving you a very long-winded answer, the important issue here to consider is that this is purely elective. Your surgeon should provide you with the information you need to make the best decision FOR YOU. This means providing you with information about the procedures (injections, peels, surgery) that are possible and the risks, benefits, recovery period, and cost of each. You must weigh this with what you think bothers you most, your timeline for recovery, and what you want to spend.  Importantly, remember that physicians may be biased towards their own expertise (no fault of their own), so seek a few opinions (as you have done).

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

Appropriate age for a Face Lift depends on degree of facial aging

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have seen 40 year old patients with premature jowling and neck changes that would benefit from a face lift and 60 year old patients who do not. According to a patient's genetics some people will age differently. Having the surgery done at an early age has no drawbacks, other than the patient will likely want to repeat the surgery again in 10 years when things relax in order to continue to look great.

Andrew Jacono, MD
Manhattan Facial Plastic Surgeon
4.7 out of 5 stars 215 reviews

What do I Need?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear vickifa7,

First of all, you don't "need" anything.  The real question, is what bothers you the most.  You have mentioned your nasolabial folds, and your lower lids/tear trough.  Once we have identified the issues you are concerned about, we can address them.

As for your nasolabial folds, yes they can be addressed with fillers such as Juvederm. In your case, I would recommend re-volumizing your malar area.  By filling in this area just a bit, it will help return the youthful heart-shaped shape to your face, and help reduce the depth to your nasolabial folds.  I would only use a very minimal amount of filler in your actual nasolabial folds - just enough to break it up.  A completely filled in nasolabial fold is unnatural, and comes across as such.  As for your lower lids/tear trough, I would have to examine you to adequately examine the pathology.  From your picture, it appears like your could benefit from some fat or filler being placed in your tear trough.  It doesn't appear like you have much excess skin in your lower lids.  Any minimal excess skin you do have here would become taught when this area was filled with some fat or filler.

Overall, you could treat the areas that bother you by replacing the volume you have lost.  You can either use fat from somewhere on your body like your abdomen, or a dermal filler like the Juvederm line of products.

You do have excess skin in your upper lids, but if they don't bother you, then leave them alone.

I hope this helps.


Asif Pirani, MD, FRCS(C)

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Facelift at 45

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Chronological age is not a factor in deciding on facial cosmetic procedures. Physical aging definitely is a factor in deciding when to do cosmetic facial procedures.
Facelifts can be tailored to the specific needs of every patient. Some need more some need less. It's a matter of how much physical aging has occurred.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 286 reviews

Facelift in 40's

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The only person who can answer if you are ready for a facelift is you; nobody else including doctors can answer this question for you.

Once you inform yourself about the recommended procedures, you will have to decide whether it is worth it or not.

Technically speaking, there are many procedures including a facelift, necklift, cheek, eyelid, volume augmentation and brow surgery that would benefit your appearance and make you look younger and prettier.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Facelift & Age

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The treatment of facial aging in younger patients should be individualized based on the patient’s aesthetic goals, anatomic findings and social situation.  The best results are usually obtained with facial rejuvenation surgery, but in some cases the patients aesthetic goals can be accomplished with temporizing maneuvers.  In these cases injectable fillers may be used with minimal disruption to the patient life to accomplish their aesthetic goals.  In this way, patients can buy time and delay a surgical procedure until it fits into their lives.

Injectable fillers offer a temporary solution to the facial aging problem and need to be repeated at frequent intervals.   It’s not unusual for patients to eventually tire of this routine for several reasons.  As time passes and the facial aging process continues injectable fillers become less effective at reversing changes associated with aging.  In addition, over the course of time it can become very expensive.  For these reasons many patients who initially buy time with fillers eventually elect to undergo facial rejuvenation surgery.

In this group, facelift, browlift, and blepharoplasty may all be indicated to reverse the aging process.  Procedures are usually less aggressive at this age, with shorter recoveries and lower complication rates.  Patients undergoing early intervention for facial aging report high satisfaction rates.

Facelift yet?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


Best Age to have a Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

This is a very common question.  The best age to have a facelift depends on: anatomy, expectations, and surgeon.

First of all, if you like what you see when you pull in the mirror, there is a good chance that you are a candidate for a facelifting procedure.  My younger patients are starting earlier as a maintenance and prevention strategy.  They are not waiting until they have a lot of sagging or they look like an older relative.  

When you start younger, your results may not be as dramatic.  Rather, a younger, more refreshed appearance can be attained with subtle changes in before and after pictures.  And, a scar tissue layer is created under the skin that makes the skin less mobile and more resistant to gravity in the future.

So, if there is sagging, a lift may help you achieve your goals.

Realistic expectations are key.  Everyone wants perfection, even the surgeon.  Keep in mind, perfection is not attainable, the goal is to get significant improvement that looks natural.

And, the most important decision you will make is the artist/surgeon that you choose.  Some surgeons like to focus on the more traditional facelifting procedures, while other surgeons like to focus on smaller procedures.  You should find a surgeon that is very well experienced performing all three procedures as this will allow you the most versatility in your outcome.

Best of luck, and let us know if you have any other questions!

Richard Castellano, MD
Tampa Facial Plastic Surgeon

Facelift at 45 is this premature?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Chronological age and facial aging differ in patient to patient. I have done Facelifts on many 45 year old women due to the fact this is what they needed and desired. In your case I can see a side view of the neck area. In reviewing your photograph and not being able to speak with you directly my advise would be to start with an endoscopic brow lift with mid face extension. This means you get a lift in the mid face, under and above the eyes with the endoscopic approach. I would also use some fat transfer into the mid face to restore some lost volume. This is a perfect procedure for patients under 50 and then you can move to a lower facelift when needed years down the road. It is important to go to a good facial plastic surgeon who understands this procedure as you do not want to lift only your brows. The endoscopic lift is done by a small scope this lift the facial tissue away from it's attachments. The entire facial unit of skin, muscle and soft tissue is then lifted upward and laterally. This technique allows the entire face to be restored to it's earlier position before the aging process took place. The procedure is done without elevating the brow high or altering the patients hairline. The results are a natural youthful appearance with little discomfort and minimum downtime.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 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.