Do I Need a Facelift, Skin Tightening or Fillers? (photo)

I am 54-years old, single and professional so I'm super busy. I'm noticing many signs of aging like sagging jowl lines, sunken cheeks and I've been using Botox and fillers to keep aging at bay but now my neck is sagging so I'm not sure if I could get by with a "mini-lift" and fillers and/or skin tightening or is it time for a full face/neck lift?

Doctor Answers 42

What Should You Do?

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Thank you for the great question, Catherine.  This is a very common dilemma that many of my patients face. The answer lies in your conceptualization of the outcome, your willingness to have downtime, and the duration of result that you seek.  Obviously, the best and most durable results come with surgery.  The photos show descent of the cheeks early jowl formation, combined with skin laxity in the neck.  For patients in your category, I offer a modified facelift with lateral platysmaplasty, which we describe as a "Prelift".  A link to a patient experience is given below.  The downtime in terms of swelling and bruising averages about two weeks. If you have no tolerance for downtime, a minimally invasive alternative which uses focused ultrasound waves (Ultherapy) can provide some benefit for about two years.  This can be provided along with minimally inavsive facial volumization techniques such as Sculptra or Voluma.  Good luck in your search!

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

Better candidate for non surgical procedures

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Your photos suggest that you would get a good improvement from non surgical procedures. Thermage for the neck and jawline, and judicious use of dermal filler. At most perioorbital fat transfer would give you a great facial rejuvenation. The main question is where are you re the menopause as that would guide my strategy and your options?

Facelift, Skin Tightening, or Fillers

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This is all dependent on the components of aging, facial fat loss and not skin sagging. If you have minimal to no jowls then Fillers may be appropriate, but if one has excessive skin then a Facelift procedure may be needed.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

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Face and Neck Lift for Longer Lasting Results

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You would get the best results with a full face and neck lift because the deep muscle of the lower face and neck would be tightened, resulting in a longer lasting effect. One way to determine whether a face lift would be helpful is to lie completely supine (flat on your back) and look at your face in the mirror. This will help to give you a general idea of how your face would most likely look after a face lift.

Wandra K. Miles, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 3 reviews


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You are in a good position for facial rejuvenation surgery at your age. In my experience, the patients do well with composite surgery ( face, eyes, brows) in your age group with a high level of satisfaction. get a consult and exam from a board certified plastic surgeon in your area. All the best

Full facelift or mini-facelift

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While I am usually not a huge fan of a mini-facelift, in your case, it will probably give you a very good result. You have good bone structure, mild laxity and are not heavy-set. As a result, a mini-lift that is done by an experienced facelift surgeon should give you a good result.

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

Face lift or fillers

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Thank you for your question about a face lift. You have lovely bone structure.

  • SMAS flap face lifts look better, last longer than mini-lifts,
  • Consider tretinoin skin care and a TCA peel or non-ablative laser such as ND Yag for fine lines of your face and neck,
  • if the right temporal atrophy doesn't bother you, leave it alone, if it does, consider a filler at surgery. Hope this helps!

Facelift or fillers

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In my practice, you would likely be seen in the non-surgical side of the office.  I think Sculptra and Ulthera would be a good start. A visit with a plastic surgeon who does facelifts only may not be ideal as you may not have all your options outlined.  Make sure non- surgical alternatives are offered as your schedule may not permit recovery from surgery.   Best wishes!!

Choose a local anesthesia facelift

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   Fillers are short term and not indicated for the problems visible in your neck. The difference between a mini-lift and a full facelift is a matter of degrees. An experienced facelift surgeon will simply do the amount needed to make you look more no less. Looking at your pictures you are closer to a minilift in degree of work than a full facelift. The area above the oral commisure (corner of the mouth ) pretty much looks fine already, most of your problems are the jowls and the neck areas. This is 80% post-auricular necklift and maybe 20% pre-auricular face work. You are a great candidate and all these areas should be cleaned up easily under oral sedation and local anesthesia in 1 to 2 hours

Aging requires a multifactorial approach

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Analyze your face by regions: Upper third (from hairline to "radix" bridge of nose) is remarkable for highly arched brows and is kept smooth with Botox.  You may consider Sculptra to fill in the temporal hollows ( the right volume loss is greater).Middle third (from radix to the base of the nose) also shows some lipoatrophy (volume loss), again more on the right, particularly around the orbital floor.  If you elect the nonsurgical approach, tear trough augmentation with hyaluronic acids, such as Belotero or Juvederm Ultra are useful in small amounts, because they tend to persist in this anatomical zone for a long time. The lower third (from base of nose inferiorly, including the neck) is where you and most individuals experience the most significant volume loss i.e.: marionette's lines, fish gill (vertical lines) and mandibular jowls.  Considering your heavy professional obligations and early stigmata of facial aging, I would recommend trying some of the collagen stimulators such as Radiesse and/or Sculptra until such time as your neck skin laxity motivates you to choose surgery.  These do not preclude you from future surgery.  Good luck:)

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 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.