Advice for 43 Year Old Considering Facelift?

I am a 43-year-old (athlete) with facial volume loss, a turkey neck, and signs of jowls just beginning to form. I recently had a consult with a plastic surgeon who recommended a deep plane facelift, as it would give the best and longest lasting result. He also told me a facelift at this age would ultimately hold up better than not having it done, as the muscles and other deep facial structures would be fixed in place, thereby making them more resistant to the natural downward migration of tissue in the aging process. Is this true?

Doctor Answers 12

Facelift for a 45-year old

Aging is dependent upon your genetics. If the patient has significant facial fat loss and jowling, one could consider doing a “Lift & Fill” facelift. I would usually not recommend a “Deep Plane Facelift” as it has certainly not been shown to provide a longer-lasting facelift result, but does increase morbidity and recovery. I do recommend that you see a true facial rejuvenation expert with Expertise and Experience and has Exceptional results in facial rejuvenation. Especially, in the younger age group so that you have a natural look and not a “windswept” Hollywood appearance.

Dallas Plastic Surgeon
4.9 out of 5 stars 48 reviews

Facelifts at 43 years of age

A facelift is indicated if you have enough descent in the cheeks, jowl formation along the jawline and laxity in the neck regardless of your relatively young age. The situation requires careful analysis though and it sounds like in your case, the only issue requiring surgery is the neck laxity. Facial volume loss can be improved by repositioning of the descended tissues, but if you are exceptionally thin, injectable volume enhacement works better.

Also, it has well been shown that the variety of facelifts including SMAS lifts and deep plane lifts have similar long-term effects as long as the deep tissues are addressed so don't be "sold" on the deep plane as there are far fewer sureons performing this anymore. The SMAS lifts are more versatile and the vectors of tissue repositioning re much more adjustable for the optimal result.

Facial rejuvenation


Thank you for the question.  Facial rejuvenation is the process of reversing some of the signs of aging including volume loss and sagging soft tissue and skin.  A face lift may be needed to improve the sagging part of aging but it will not address the volume loss.  Often, fat grafting is combined with face lift surgery to accomplish the best result when volume loss is also the case.  I would define your aesthetic goal and seek consultation from several board certified plastic surgeon.

All  the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 153 reviews

43 year old facelift, which plane?

The basis of a facelift is not pulling the skin rather it is repositioning of tissues under the skin and then re-draping the skin over the more youthful understructure. In some patients neck liposuction, fat grafting and other procedures to the eyes or forehead are done concurrently. The quality of the skin, loss of volume, or descent of tissues can only be accessed by a physical exam. Also each surgeon has a technique which works in their hands.  I would be less concerned about the plane of dissection and more focused on before/after and comfort with the surgeon.  Consult with a board certified plastic surgeon to get a detailed exam and treatment plan. Most have complimentary or low cost consultations.

Best Advice For A Facelift

The key for any facelift is does it address the proper anatomic cause of aging and your individual anatomy.  At 43 years of age, one of the key issues for you would be laxity of the skin, to determine which procedure would be best for you.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 141 reviews

43 years of age may be a bit young for deep plane facelift

At 43 years of age, it sounds as though you are a bit young to have a deep plane facelift. The goal of a face/neck lift surgery is to remove fat from the neck both above and below the platysma muscle, tightening the jowls, and removing any excess skin. Hollowness will not be improved with a facelift since it tightens the skin. The deep plane facelift has a higher complication rate, which should be discussed with your surgeon.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Facelift in a 43 year old

The selection of the appropriate facelift procedure does not depend on your age, but rather your individual degree of facial aging. Without seeing pictures, my best advice is to get a second opinion. You may ulimately choose to have the deep plane lift.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 37 reviews

See a plastic or facial plastic surgeon who is a facelift specialist.

 Get a second opinion and see what another experienced facelift surgeon says after he is able to examine your face. Also, a facelift resets the clock---it doesn't stop it. So you will continue to age.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews

Deep plane facelifts increase the risk of permanent motor nerve injury

Dear Jenny

One has to be careful what you look for. The deep plane facelift is a technical tour-de-force. The anatomic dissection is requires an in depth knowledge of the facial planes and the anatomy which requires intimate exposure of the facial nerves to carry out the deep plane dissection. The deep plane facelift can results in motor nerve damage in up to 3% of cases although the incidence of permanent damage to the nerves is less than 1% of cases. If the deep place facelift made for a better, longer lasting facelift result, this might provide a rationale for taking this increased risk.

However, a number of studies have demonstrated to benefit of the Deep plane face lift over safer means of perform the facelift such as SMAS flap or even tight the SMAS with sutures and not actually incising it. Why do surgeons persist in performing the higher risk procedure? Some might say it is machismo. However, I don't think it is reasonable to put people at greater risk just to satisfy the thrill seeking of the surgeon.

One other thing about the deep plane is that many end up with an other pull look form this procedure. I am now fairly convinced that this effect is not inherent to the deep plane method but rather the bias of certain surgeons to try and get the biggest affect event if the result is not an aesthetically optimal result (Mach 1, or wind tunnel look).

I would encourage you to seek a variety of opinions and in particular by attention to the before and after images. Be critical. You will be shown what the doctor considers their best work. Look at the edges of the mouth, evidence that the cheek fat pad is over pulled and how the ears and hairlines are tailored. If you don't like what you are seeking, don't expect your results to be any better.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Careful analysis

Facial rejuvenation is dependent on careful analysis. I will usually have patients bring in photos from their part to see the changes brought on by aging, weight shits, environments as well as to deterine what their baseline anatomy is. We are have the same elements but are constructed differently to give us a different appearance. Analysis is key. If most of your effects are due to loss of volume, there are many approaches to restoring volume . Sometimes there is volume loss on top of baseline anatomical features that contribute to disproportionate aged look. it would seem that if you have diagnosed the volume depletion yourself, that that is indeed a significant factor. You also have to decide if you want to restore your previous features ot change them in some significant way. I will usually see a patient over two or three sessions before making recommendation based on a customized approach.

The important unknown factor in post-op results is the programmed natural aging process in an individual person following surgery. If we don't know how a person is going to age in five or ten years without their surgery, how can we predict what they will look with surgery?

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 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.