What Facial rejuvenation would you recommend at age 41? Is facelift the only answer? (photo)

I have recently noticed that my mouth corners have turned downward and I appear to have a permanent frown. I have pretty good skin but feel like my skin has started to droop especially around the mouth area. I don't want my chin area to look wide using fillers. Is facelift the only answer? Thank you for your advice!

Doctor Answers 25

Facial Rejuvenation

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A Facelift is certainly not the only option, or perhaps not an option for you at all at this time. In order to make an appropriate assessment, you would require an in person consultation or many more photos from different angles. It is very possible that at your age, you could benefit from non-surgical procedures. For instance, Botox can help turn up the corners of the mouth.  I agree that you don;t want a heavy looking lower face, but  a very small amount of Juvederm could fill in those small lines a bit more and make the area around your mouth more youthful. Lasers for skin tightening can also be very effective for some people. Anyone with hanging skin is absolutely NOT a candidate for laser skin tightening, but you aren't there.
Your face is pretty and youthful. Starting with these minor enhancements, and maintaining a good skin care routine, including professional peels may be all you need right now. 

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Look at younger photos of yourself before making any decisions.

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Hi Meaganmeagan,

I would not recommend any procedures for you without seeing some younger photos of you in your prime, when you felt you looked fine.  This is the approach that I take for facial rejuvenation consults.  I can assume that I know what you looked like when your were younger, but you know what happens when people assume.  I find that looking at younger photos is like helping to make a diagnosis, before recommending a treatment.  Asking questions such as weight loss, recent menopause, injections of botox or fillers, etc, can all help figure out what happened to a particular patient.  The downturn mouth is the symptom, but what is the cause of the symptoms, what is the diagnosis?  If facial fat loss is the diagnosis then perhaps you may want to reverse the cause of the problem and try to replace the volume loss based on your younger photos.  Did you have botox to your masseter muscles?  If so, perhaps this is the cause of the problem.  Let's say that you actually like the thinner face, and don't necessarily want a fuller face, but only want to treat sagging around the mouth or jawline, then it is worth exploring the facelift option.  However, I would not make a recommendation of what you should have without more information.  Certainly a facelift is not the only answer.

Some times we are seeing the effects of aging (down turned corners of the mouth) but the cause of the aging may be elsewhere.  I suspect that you are of Asian descent, and if so, when you were younger your cheeks were probably fuller.  It is actually very hard to turn the downturned corners of the mouth from fullness.  If the patient has loose sagging tissue that loosely hangs down by the marionette line area and very easily smooths out with lifting by the temples, then a lower facelift may help.

Your tissues seem tight and full and it would appear that a very firm pressure would be need to make any difference on the droop around your mouth area.  Our bodies and faces do not like tension, and will always relax that tension over time. 

One observation I have seen in Asian patients, is with Botox masseter reduction.  In younger patients, it does not seem be an issue, but in patients in their late 30's and up the loss of muscle volume at the angle of the jaw, seems to cause some jowling and sagging around the mouth.  If they stop the botox and rebuild the size of the masseter back to pre-botox levels, the masseter muscle act as an jaw angle implant, but it is really your own muscle volume.  This seems to help reverse some of the sagging along the jawline because the skin and tissues now have to wrap around the bigger masseter muscle. 

I hope this made some sense, and good luck on your facial rejuvenation journey.


Dr. Yang

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George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Non-surgical options...

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I agree with your concern about adding volume to the lower portion of your face. There are a few devices that may help for now.  Exilis is a non-ablative skin tightening procedure.  Ulthera is another.  Neither of these will produce a "facelift result," but both may get you a little tightening along your jawline to put off the facelift a few more years.  You are awfully young to start with surgery.  There is very little to lose with either Exilis or Ultherapy.  I suggest seeking out a surgeon in your area that provides one of these technologies and discuss with them.  If you see someone that only does does injections, that's what you'll get!  Good luck.

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 17 reviews

Facelift the only answer?

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You have good skin but now are experiencing signs of aging.  One of your options would be a facelift but less drastic measures are available such as fillers and botox, hydrafacial treatments, etc.  Please see your board certified plastic surgeon to discuss the different options for you.

Anh Lee, MD
El Paso Plastic Surgeon
4.9 out of 5 stars 42 reviews

Facial Rejuvenation Consultation

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Age is not as much of a determinant of what is needed as is listening to you so as to determine what your goals and expectations are. This is the value of a consultation. At your age, the most common issues are: gravitational descent of your tissues, volume loss, and loss of skin elasticity.
there are non-surgical and surgical choices for each of these categories. Computer Imaging can show you the diffeerences and help you make whatever decision is the best fro you.

Greg Chernoff, MD
Indianapolis Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

Facelift vs non-surgical treatments

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Thanks for sharing your question and photos

You look great, and it appears that you take good care of your skin.  Skin care is always a great place to start.  In the photos I only have a view of the middle and lower third of your face so it would be difficult to make comprehensive suggestions about any surgery to achieve facial balance and harmony.

I think you would do well with incremental treatments of injections such as an HA filler like juvederm to targeted areas, and perhaps an office based laser could also provide skin tightening.  I would suggest a regimen of skin care for 4-6 weeks to prepare your skin then I would treat with a Fraxel laser, we have 2 types in our office and then I would follow that with focused injectable treatment.  I think it would provide you great benefit

Visit with a plastic surgeon in your office that can offer you a consultation and custom treatment plan.  I often share before and after views with patients that have similar skin tone and texture to help them understand the improvements I have seen in my practice with various treatment.  I hope this is helpful

Best of luck to you.

Steven Camp MD

Steven M. Camp, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 121 reviews

Are You a Candidate for a Facelift

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A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift.
During your #consultation,  your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.
If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Options to facelift

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It is not possible to say without seeing a photo of your entire face.  It is possible that you have lost volume in your cheeks causing your tissues to sag creating the early signs of Marionette or puppet lines.  Sometimes fillers or even better fat transferred to the the cheeks can actually lift this area.  This is sometimes referred to as a "spacelift" because you are lifting the tissues by replacing lost volume rather than lifting with incisions and suturing.  Only a live consultation can determine what will be your best option.

Jeffrey Marvel, MD
Nashville Facial Plastic Surgeon
4.6 out of 5 stars 56 reviews

What Facial rejuvenation would you recommend at age 41? Is facelift the only answer?

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Dear Meaganmeagan,
Thanks for the question and photos. It is impossible to give you specific recommendations without a face-to-face consultation but I can answer in generalities. You appear to be a pretty and youthful 41 and it is likely premature to be thinking about surgical solutions. For anyone considering improvements to your appearance, professional skin care is important. If your skin looks great, everything looks better. Personally, I use and recommend SkinMedica products. You appear to have some early laxity around the corners of your mouth. The remarkable new hyaluronic acid filler works surprisingly well to "unfurl" this skin and give you lift at the corners of your mouth - but not by injections in that area! Voluma is a very sculptural filler and when properly placed high in the cheeks and over the cheekbones correction can be achieved in your lower face. Botox can also be used to lift the corners of your mouth.
Be sure and consult with an experienced board certified plastic surgeon or facial plastic surgeon to learn all of your options. Best wishes.

Kevin L. Smith, MD, FACS
Charlotte Plastic Surgeon

Facelifts or fillers possibilities at age 41

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The changes in the face due to aging are relatively modest. Fillers could be used to correct some of the contour. The skin looks to be an excellent condition.

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.