Is it too soon for me to consider surgical procedures for aging? (photos)

I am 46. For 2 years I have been getting Radiesse in my upper cheeks, Boxtox around eyes, and various fillers around my mouth. I have recently requested a mini-face lift, upper and lower bleph and cheek implants. Injectables don't help the lower cheek sagging or loose eye skin. My plastic surgeon thinks it's too soon for surgery, particularly lower bleph. Note that I received Voluma in my upper cheeks and Botox around my eyes just 8 days prior to photos, and Juvderm around my mouth 4 months ago.

Doctor Answers 21


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Thank you for the pictures.

I would suggest upper and lower blepharoplasty (eyelids). Some fat transfer to the cheek area to give it a little lift and at the nasolabial fold as well.

Dr. Campos


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On reviewing your photos the problem is mainly mid face decent with fat bulging in lower lids. Injections do a poor job in making you appear younger. Instead what would serve you best is an endoscopic mid face lift, lower eyelid fat removal and Sciton laser to remaining lines on the lower lids. The midface lift is most important as it would restore your facial shape vertically back to where it was at least 10 years prior.

Mark Prysi, MD
Naples Plastic Surgeon

Face lift or more injectables

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  • First, research shows that a face lift done before 50 is likely to have better, longer lasting results,
  • Second, your face has clear indications that you will benefit from surgery.
  • The point of injectables is to do temporarily what surgery cannot do permanently.
  • Based on your photos, I suggest - an upper lid lift, skin only - you have minimal fat; 
  • A lower lid lift with re-draping of the fat over the gone - probably. A careful exam is needed.
  • A lower face and neck lift with fat transplants where needed, at least the cheek folds and around the mouth.
  • Bring a photo of yourself at a younger age to your surgical consultation for planning.
  • The smile lines around your eyes will always need Botox. 
  • Given the changes in the photo immediately after fillers, I am surprised that your plastic surgeon does not see what you need. I assume /she is a Board Certified Plastic Surgeon. If not, you need one. Best wishes - 

When do you have surgical procedures?

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when you have problems that can be address successfully and predictably with procedures.  Since you have had so much fillers and Botox, it clouds the real issues here.  Have a frank discussion with your surgeon and find out why 'its too early' as your photos suggest appreciable results being obtained with surgery.  Much depends on how much of a result you want... you will achieve subtle results at this time with the facelift and more obvious results with the lower lid blepharoplasty.  But you can also achieve similar results with laser resurfacing.  But if your surgeon is adamant in his position, there are plenty of other qualified doctors who will be more than willing to help you achieve your goals if it remains imperative to you to do this.

Eyelids and a mini-lift

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The injectables you are performing are certainly acceptable at your age. You are not yet ready for mini-lift or facelift. You are an excellent candidate for an upper and lower eyelid blepharoplasty.
The primary goal for upper eyelid surgery  is to remove hooded skin touching the upper eyelashes and a small amount of orbital fat as well.
The primary goal for lower eye lid surgery is to remove  a conservative amount of the 3 fatty compartments on the lower lids creating the" puffy" look. The fat is removed  from trans-conjunctival approach. Patients with excess skin on the lower lids also will require a pinch technique  to remove extra skin on the outside of the eyelid. This incision was closed with tissue glue. For many examples, please see the link below to our eyelid surgery photo gallery

Too soon to consider facial rejuvenation?

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Botox, Juvederm, Voluma and Radiesse are worthwhile in the appropriate patient. Based on your photos and limited history, most experienced artistic plastic surgeons would feel that you have enough signs of aging to consider performing surgical procedures, which will be much longer lasting than the non-surgical procedures that you have undergone and ultimately may be more cost effective.  

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Is it too soon for me to consider surgical procedures for aging?

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I think this is the perfect time for facial rejuvenation surgery!  In their mid 40s, women do tend to have sagging skin and look tired!  Yes, a blephroplasty will also help, as you have fairly significant fatty deposits in your lower eyes.  

Is it too soon for me to consider surgical procedures for aging?

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Yes I think you are a candidate for mini FL/NL+upper lids (on fence on lowers), with additional liquid facelift injections. To me you were under treated in volume. I think additional Voluma like 2 cc's, Juvederm 2 cc's, Belotero for tear troughs 1 cc. could help. The major issue with "liquid FaceLifts" is under volume injections... 

When it is too soon to consider facial rejuvenation surgery?

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You have excellent skin and appear to have benefited from multiple nonsurgical facial rejuvenation procedures including fillers and Botox.

However in my experience patients generally have better and longer lasting results when they have their facial and eyelid rejuvenation procedures done in their late 40s as opposed to late 50s or 60s.

I do think you can certainly benefit from a 4 lid blepharoplasty to correct the eyelid aging changes.  I often suggest that this be the first procedure a patient tries because the eyes are the window to the soul and eyelid rejuvenation has the most dramatic impact on the face.

Your lower face and neck looks to be in good shape and I would not encourage you to have a facelift at this time to concentrate on eyelid rejuvenation.

Too Soon for Surgical Procedures for Aging.

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46 is certainly not too soon to consider facial rejuvenation surgery, but it really depends on the person. Some people develop noticeable signs of facial aging in their early forties while others can get into their late fifties before they feel the need to consider facial rejuvenation. So the decision as to when to intervene surgically is very individualized.

As to your surgical plan, I don't see the need for cheek implants. You appear to have a good degree of fullness in your upper cheeks, which you apparently also recently increased with Voluma. A well executed limited incision (mini) facelift should further improve the fullness in your upper cheeks. I think the addition of a cheek implant just runs the risk of making you look unnatural. If you wanted a little extra fullness in your cheek area you could consider autologous fat transfer which has a much softer and natural appearance. 

Your photos indicate that you definitely have visible lower lid bulges or orbital fat pads, and a tranconjunctival lower lid blepharoplasty would make a noticeable improvement. You also look like you would benefit from an upper blepharoplasty, but your surgeon will need to do something to minimize secondary descent of your eyebrow because your eyebrow position is also trending lower. That could be accomplished by doing a lateral obiculopexy as part of your upper blepharoplasty, or by extending your facelift incision into the temporal area and doing a limited temporal brow lift. If you want to continue to use Botox in your forehead to keep it smooth, a more complete endoscopic brow lift might be a consideration. 

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.