I'm a 47 year-old woman and I am unhappy with the changing shape of my face. Please recommend filler or face-lift. (photos)

It seems to me that a loss of volume in the cheek area is causing everything to look out of balance. My nose looks larger and my eyes sunken. I am also not happy with the laxity in my neck and jaw. My mouth has almost completely disappeared. Please reccomend face lift or fillers to restore balance.

Doctor Answers 29

Facial Aging

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You are right about the cause of your issues. This is the common early reason of facial aging. The most effective way to regain firmness of the jawline, uplift your cheek-cheekbone area and reduce the drawn look if a vertical facelift with simultaneous fat grafting to restore the youthful position and volume of your features. This rejuvenation philosophy is the basis of my RefresherLift. Fillers and fat will never be parallel the result of a proper lift and will only produce less than optimal results!

Christian Drehsen, M.D.

I'm a 47 year-old woman and I am unhappy with the changing shape of my face. Please recommend filler or face-lift.

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Thank you for your question.  This is a question we answer many times in my practice.  Based on your pictures, I believe you would be an excellent candidate for a facelift.  A facelift is designed to rejuvenate and lift the loose and sagging skin around the midface, jawline and neck.  Also during this procedure, the muscles in the midline of the neck can be tightened to help remove the laxity which is in the center. This is typically perfomed as an outpatient (or overnight observation) procedure. 

Filler is a wonderful option, as well.  Hyaluonic acid based filler such as Juvederm or Restylane can be used in the midface, around the eyes and smile lines, and along the jawline to help rejuvenate these areas.  However, fillers are not permanent solutions and may need to be repeated in the future. 

I would consult with a board certified facial plastic surgeon or plastic surgeon who specializes in facelifts and facial rejuvenation.  Here you will have a full evaluation and be able to discuss your goals for surgery.  I hope that this helps!

-David Gilpin 

David Gilpin, MD
Nashville Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

I'm a 47 year-old woman and I am unhappy with the changing shape of my face. Please recommend filler or face-lift. (photos)

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I would recommend both a facelift and fillers. As we age we lose facial volume and facial tissues sag. A complete approach addresses both of these issues. I frequently do fat grafting during facelifts, but synthetic fillers can be used as well. Consult an experienced facelift surgeon who can discuss all of your options. Good luck.

Warren J. Katz, MD
Dallas Facial Plastic Surgeon
4.8 out of 5 stars 19 reviews


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A facelift or a necklift is used to correct the lower-third of the face.  Many patients consider a facelift involving the entire face; however, it really only addresses the lower-third.  The key part to correcting the aging process of the lower face, is to correct the structural problems of the face and neck.  As we get older, the muscles and ligaments of the face begin to get lax and become “droopy.”  This gives the patient a very tired look to the lower face.

If the skin of the lower face is just pulled without correcting the underlying structural issues by tightening the muscles and ligaments of the face, the face has a very “tight” or “pulled” look, as this is exactly what has happened when the surgeons have pulled the skin too tight.

The critical part of correcting this lower-third of the face is to tighten the structural portions of the face by tightening the muscles and ligaments.  Once this is done, the skin is very gently put back down on the face, leaving the patient a very natural, youthful-looking lower face, jawline, and neck.  This also allows for a longer-lasting result, as the structural portions of the face have been elevated and tightened and there is no tension on the skin.  Unfortunately, the skin is very elastic and will stretch out very quickly if the structural portions of the face are not corrected.

The key to giving the face a very natural, refreshed look is tightening these muscles.  This is oftentimes referred to as a deep-plane facelift or a structural facelift.

Lawrence Scott Ennis, MD, FACS
Pensacola Plastic Surgeon
5.0 out of 5 stars 162 reviews

Aging face recommendations

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You do display typical aging face changes, including volume loss in the midface and periorbital areas. Depending on your price range of course, I would recommend fat transfer to these areas as my number 1 recommendation, followed by Botox and fillers, and a conservative facelift if you want to improve the lower face and neck as well. I do not recommend cheek implants as you have good bone structure.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews


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Thank you for your question and sending images. Although it is impossible to give an exact diagnosis and plan just from images, it does appear that you could benefit from a lower facelift. If not more important, however, is the volume loss that you are seeing throughout the face. Any plan for your facial rejuvenation should address this. Options include in office injectable fillers such as Juvederm (Voluma XC, Ultra XC and Vollure) or Restylane and fat augmentation. If you feel you are not ready for surgery, another option would be fillers combined with nonsurgical tightening such as Thermi RF or Viora Reaction.

I would recommend consulting with a board certified facial plastic or plastic surgeon to explore surgical and nonsurgical options for facial rejuvenation.

Mark Hamilton, MD
Indianapolis Facial Plastic Surgeon
4.8 out of 5 stars 50 reviews

Unhappy with the changing shape of my face. Please recommend filler or face-lift.

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 Hi, I have performed many SMAS facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS.  From the photos your cheeks are flat in the front (more son on one side), jowls are present and I suspect that the chin is weak by the presence of a shallow mental creases.  A non smiling profile photos would allow evaluation of the chin projection to confirm or rule out a weak (lack of forward bone support) or ptotic chin (sagging chin muscle).  These factors combine to create a rectangular shaped face. 

 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions and no incisions extend or are placed within the hair.
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed from the face and neck
  • excess skin removed from the face and neck
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Lower face / neck lift, filler, and fat grafting

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Hello and thank you for your excellent question. Based on your photos and description, I would recommend a lower face and neck lift (mainly to treat the neck), a filler like volbella to the lips and possibly tear troughs, and either fat grafting or voluma to the cheeks and cheekbones (i.e., malar area). These are not the ONLY options, but just my suggestions based on the information provided. It is essential that you have an in-person consultation to develop a treatment plan that specifically addresses your personal surgical goals, and your body’s anatomy. Preoperative visualization and surgical simulation with the Crisalix system may help refine this plan. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!


Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Texas “Top Doc”

Facelift: Surgical vs Non-Surgical

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Hi cdm99,

Thank you for your question. I recommend an in-office consultation with a facial plastic surgeon or plastic surgeon for a thorough evaluation and discussion of the available surgical and non-surgical treatment options. My practice is based in nearby Chicago if you are looking for a facial plastic surgeon in the Midwest. It is hard to recommend the most appropriate treatment options from only looking at photographs and without an in-person exam. I often perform filler treatments on patients to restore volume to the cheeks, temples, and the areas under the eyes to bring more attention to the cheeks and eyes as well as to enhance lip volume and turn up the corners of the mouth. 

Steven H. Dayan, MD
Chicago Facial Plastic Surgeon
4.3 out of 5 stars 33 reviews

47-year-old woman and I am unhappy with the changing shape of my face

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Fillers off for a temporary augmentation to the midface area, while cheek implants offer a permanent solution to the flat cheek profile.  A lower face and neck lift is required to tighten loose facial and neck skin, which is normal for your age.  A rhinoplasty procedure can accomplish decreasing the overall projection of the nose, narrowing the nostrils, shaving down the dorsal hump, and refining both the tip and the bridgeline.   For many examples of these procedures, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 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.