What type of facial surgery would I benefit most from?

Question

I have just turned 37 and have noticed I am aging a lot quicker than my friends. I have quite a bit of jowling already, saggy eyelids and neck skin. I am looking into surgery and am leaning toward a full face and necklift as well as upper and lower bleph. Would these procedures be the best options for addressing my concerns?

Ajaya Kashyap, MD · Answer

Thank you for your query. A full face and neck lift with upper and lower blepharoplasty, and some fat grafting  will certainly address all your concerns.. There are other non-surgical or minimally invasive options that can help as well at your age. These include invasive radio frequency tightening with autologous fat grafting or fillers. I sometimes combine subperiosteal mid face-lift with fat grafting, and Thermitight for the lower  face and neck to achieve good results in your situation. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Gary M. Horndeski, MD · Answer

I do not believe you would benefit from a necklift as you neck appears pretty well defined. However, your eyebrows look low. I recommend you consider a frontal browlift. This will lower your hairline, make you look younger and pull up your eyebrows as well as lift the upper eyelids. You may also benefit from a rhinoplasty to increase the tip angle of the nose and possibly a chin implant. This would align your profile better. You are too young for a facelift.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

Based on these photos it looks that transconjuctival lower blepharoplasty and neck lift may be considered; periorbital fillers or even a fat grafts as well. In person consultation with a board certified plastic surgeon with experience in facial rejuvenation would give you the chance to discuss a non surgical options as well. Good luck.

Jeffrey M. Darrow, MD · Answer

Your skin quality and elasticity should be excellent at 37 years old.  Your overall facial shape, jawline, contour, and neck are very good. I would think that you would benefit most by a mini facelift with a suture plication of your SMAS, which could help to improve your jawline and improve the contouring in your neck.  A skin only resection of the upper eyelids should help rejuvenate your eyes but I don’t see any pressing need for surgery of your lower eyelids, although you may consider some volume restoration of that area.  An extended SMAS full face/neck lift is an option but may be considered slightly too much at your age.  Visit a qualified, board-certified plastic surgeon for a detail consultation. Best wishes.

Ruslan Zhuravsky, DO · Answer

I wish I could give you a simple straight forward answer, but it really depends on your expectations. As we age there are 3 main things that occur: qualitative skin changes, laxity of facial structures under the skin, and volume loss (from fat and bone). Each is treated with different modalities. Also, everyone ages differently based on genetics, hormone levels, smoking/sun exposure, diet, maintenance, etc ... You have great bone structure which a big plus as this is the supportive framework of the face. While I no longer use age as an absolute contraindicator for a facelift, we try to avoid it when possible in the younger patients. Typically, more minimally invasive procedures like factetite/necktite, j-plasma, evoke, ultherapy etc ... are suggested to get mild to moderate improvement and stave off a facelift for a later day. I personally use facetite / necktite (in combo with morpheus) very frequently with great results, but I also choose my patients wisely and consult them on what to expect. The results are variable ranging from mild to moderate improvement. In most case this is what the patient is looking for. Based on your question, I get the feeling your are looking for something more definitive and significant, so I would not take facelift off the table. However, this really requires a thorough discussion with your surgeon. Make sure it's someone proficient in both types of interventions, so their recommendations are not biased but based on you best interest. Upper bleph is something I have done even for patients in the 20's. It can be a very nice procedure. Just make sure they dont take too much skin, or remove fat ... that can lead to a hollowed eye appearance and age you even more. For the lower lids, it seems the main issue is hollowing, a bleph will not help with that and infact can make it worse. Volume restoration with fat or filler would be a good idea. Some volume via fat or filler can also be a nice touch, especially under the cheek, to blend it into the face and give the face a softer, more heart shaped appearance. While this isn't a straight answer, I hope the information helps lead you down the right path!

Ronald J. Edelson, MD · Answer

I would start with upper and lower lids only. You’re still young for a facelift. You can try non invasive types of skin tightening if you like but they don’t do much.

Thomas A. Mustoe, MD, FACS · Answer

You do have early howling and some minkr laxity in the neck.  A lower facelift (deep plane) woukd give a long lasting and natural result.  A transconjuctival lower lid blepharoplasty with fat grafting g along the orbital rim or fat grafting alone would improve your lower eyelids with incisions or changing eyelid shape.  An in person consultation Woukd be necessary to judge whether an upper blepharoplasty is worth it: but the improvement would be subtle u any case.

Matthew Zeiderman, MD · Answer

Given your age I'd recommend FaceTite for your neck and doing your upper eyelids. You're pretty young to be considering a full face/necklift and I think a less invasive procedure would suit you well at this time and allow you to put the necklift off for a few more years. Gravity isn't going to stop and the necklift will eventually need to be revised. Upperlids will make a big impact. Lower lids could be improed with a tear trough release and some fat transfer to the tear trough/upper cheek. You don't have a lot of extra lower lid skin, just a bit of hollowing that could use some volume. A little bit of filler or fat transfer to your cheeks could also be helpful for cheek volume and filling out the nasolabial folds.

William Portuese, MD · Answer

Consider performing just an upper blepharoplasty to remove the hooded and excess skin on your upper lids. This procedure can be done under local anesthesia as an outpatient procedure, which takes about 30 minutes. You are really not ready for a facelift yet at such a young age.

Robert Singer, MD · Answer

Facial rejuvenation varies from surgeon to surgeon and means different things to different patients. In general it is the process to try to reverse the facial appearance caused by aging. It may involve improving the skin texture and complexion, diminishing skin discoloration, minimizing fine lines and wrinkles, contouring hollows, or tightening loose tissue that has lost its elasticity.

There are a variety of procedures, both non-surgical and surgical which can be utilized to achieve these various goals. Fillers, Botox or Dysport, micro-fat grafts, chemical peels, a skin care program, lasers, skin tightening, and surgical lifts are some of the methods that are used to achieve a cosmetic improvement. Each has advantages and disadvantages as well as limitations of what they can achieve. The best technique or combination of procedures depends on patient concern, desired outcome, individual anatomy, underlying medical health, and extent of aging. There is no one approach that is ideal for everyone.

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 who has all of the modalities of treatment available. You should discuss your concerns with that surgeon in person.

Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.