Do I need a lower facelift?

Question

I hate the way my lower face and neck look. I also feel like I need an upper eye lift but I think that's pretty obvious so no need to ask about that. So, I'm wondering what exactly the experts feel would be my best option at this point. I'd love a non-invasive option but I may be too far gone for that lol Any and all opinions are appreciated and will be considered. Thanks so much! I'm posting this question again because my side profile didn't download the first time.

Stephen H. Fink, DO, FAOCO · Answer

Thank you for the photos. My opinion is that the best way I know to give you the best and longest lasting treatment is a lower face and neck lift. It all depends on what concerns you the most and what you are willing to do.  Fillers do a great job of restoring volume which you need around your chin.
My lower face and neck lift is often performed with  local anesthesia and sedation and firms the loose platysma muscle under your chin redefining your neck line. It also lifts the lower face volume up into the mid face and removes the excess skin.  Results are very natural and recovery is 1-2 weeks. From that point, you will continue to age at your rate but will be ahead by what was accomplished. There are other non- surgical options i.e. lasers type devices, threads etc. but the results duration will be less.

All my best,

Dr. Stephen H Fink
Newport Faces Cosmetic Surgery

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

Because do you have very low body fat, the contours of the lower face show more significantly and nonsurgical treatments are more likely to show their limitations.

A deep deep plane short scar facelift is likely to be the intervention more suitable for your characteristics in order to improve both the control of the jawline and the appearance around the mouth. It would also help with the slight laxity under the chin.

If when you are bringing the chin down there is more significant volume showing, a formal neck lift combined with the facelift could be a better solution. This aspect is not apparent from the photographs submitted.

Leyla Arvas, MD · Answer

Hello, yes you have sagging in the lower jaw area of your face. The lower face lift, which we call mini face lift, will provide a very effective and youthful appearance. I also recommend you to have a lip lift in the same operation. Lip lift will shorten the distance between the nose and lip and increase the youthful appearance.

Jonathan Kulbersh, MD · Answer

Hello and thank you for your question. Based on your age and photos, it appears a surgical lift might offer the most dramatic, long-lasting improvement. I would likely suggest combining the lower facelift with a neck lift to rejuvenate the entire area. These procedures could be performed at the same time and recovery is usually about two weeks. Incisions are placed carefully within the hairline and natural creases of the skin to minimize visible scarring afterward. You could also delay surgery for a bit by using some well placed injectable filler and neuromodulator, but keep in mind these improvements will be temporary and you will need to repeat the process every few months to maintain them. I encourage you to schedule a consultation with an experienced, board-certified facial plastic surgeon for further assessment and treatment recommendations.

Nelson Lee Novick, MD · Answer

From the photos provided, a volumizing filler, such as Restylane Lyft injected at the posterior angle of the jaw and along the jawline can help to define the jaw, provide some lift to the upper neck region in profile and create a less sharply angular face and more heart-shaped face in frontal view. Voluma XC, another volumizing filler for the chin region can establish greater projection and harmonize and balance the projections of the chin, lips and nose. The result of both these nonsurgical interventions, which should take no more than about twenty minutes to perform in experienced hands and engenders very little downtime. Make sure to consult with a board certified cosmetic dermatologist or other core aesthetic physician and ask to see his/her personal befores and afters before agreeing to proceed. Best of luck.

Michael I. Echavez, MD · Answer

A facelift normally addresses the neck and lower face, and this procedure should improve those areas for you.  If you wanted to try a non-invasive option, you could try Face/NeckTite.  This procedure uses radio frequency to deliver heat to the tissue under the skin to produce tightening.  Results from surgery are generally more dramatic than non-invasive options however.

Brian K. Machida, MD, FACS · Answer

At your age, it’s almost an ideal time to start considering a lift if there are problems that bother you. Well done lifts performed at this age could potentially push your appearance from your 40’s to the thirties or maybe even better depending on your anatomy. Again there are never promises with this regard but this is a potential result. It’s best to go for a personal consultation to see what you might need.

Connie Hiers, MD, FACS · Answer

You would do well with a minifacelift. I would not suggest just a neck lift since this will not address your lower face.

Barry M. Weintraub, MD, FACS · Answer

You appear to be very fit – which is wonderful and healthy – but thinness can make facial laxity more prominent. The proper age for surgery is not dependent on your date of birth, but by genetics, environment, health, and aesthetic wishes. Depending on your goals, you could consider a non-invasive treatment over a surgical treatment; however, you might need to compromise on your goals. The less invasive-option usually means that it is less effective than the surgical approach. If you wished to be conservative, you could first try a treatment such as microneedling with radio frequency to see if you can tighten the skin enough to make you happy. Such treatments do not eliminate loose skin, but instead, stimulate collagen formation to help tighten the skin. The gold standard for a tight, youthful and beautiful neck, and to improve the laxity of your lower face, is a lower-facelift and neck lift. This will gently resuspend the skin and will remove the excess laxity, leaving you with a smooth and improved lower face and neck contour. While the decision is ultimately up to you, I recommend you consult with a board-certified plastic surgeon to discuss your goals and expectations.

Robert Singer, MD · Answer

Everyone ages at a different rate. Some patients at 45 have more aging than those much older. It depends on numerous factors including: heredity, history of smoking, lifestyle, sun exposure, excessive exercising, underlying medical health, and significant weight loss.

Today, many patients opt to undergo a facelift at 45 . It really depends more on the extent of aging, desired outcome, realistic expectations, individual anatomy and if the aging process bothers you enough to do something about it. Since every patient is different, the approach to facial rejuvenation (fillers, micro-fat grafts, mini facelifts, facelifts, and combination of procedures) needs to be individualized in order to achieve a natural appearing improvement.

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

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