46, generally look very tired, suggestions on facelift procedures? (Photos)

Question

Hi all, im after please any suggestions as to ways to resolve all the skin laxity and general decent of my mid/lower face, as you can see all of my cheeks have moved south. I’m a very keen runner, low alcohol consumption but I generally always look very tired. Aged 46. Thanks in advance.

John Reilly, MD, FACS · Answer

Hello, there are a few things you can consider before deciding on a surgical facelift.

Have you considered adding some volume to the cheeks? Adding volume to the cheeks does not lift the skin or reduce the nasolabial folds as some injectors would lead you to believe, but it can enhance the balance of the face and add a little bit of fullness where needed.

I would start with a few tubes of filler to volumize the cheeks and a little bit in the nasolabial folds. I think you'll be surprised with what that can do. If you like the filler you can then consider your own fat in the future which could be more permanent. Facial fat grafting is an in-office procedure.  Good luck.

Ali Riza Öreroglu, MD · Answer

Given that you're 46 and experiencing skin laxity and descent in the mid and lower face, my recommendation would be a deep plane facelift. This technique is deeper than traditional facelifts and targets the underlying facial structures, providing more natural and long-lasting results. It will help correct the downward movement of your cheeks and restore a more youthful appearance. Additionally, for the tired look around your eyes, I would suggest lower blepharoplasty. This procedure removes excess skin and fat under the eyes, giving a more refreshed and rejuvenated look. Both procedures aim to address volume loss and skin laxity, helping you achieve a more youthful and rested appearance. A physical examination and detailed consultation would be necessary to create a tailored plan for the best possible outcome. I would also recomment facial fat grafitng to restore some volume and correct proportions

Ali Cetinkaya, MD · Answer

Thank you for sharing your concern &mdash; it's something we hear quite often from patients in their 40s, especially those with active lifestyles like yourself.
At age 46, midface and lower face descent is typically due to a combination of:
Ligament laxity (support structures loosen over time)
Volume loss (especially in the cheeks and under the eyes)
Skin laxity due to age and possibly genetics
An active, slim physique (like in long-distance runners) can sometimes exaggerate facial hollowness

John Michael Thomassen, MD · Answer

A deep plane lift would lift the malar soft tissues by dividing the retaining ligaments in that area.  As a male, you need to consider how the beard line will change with a lift and manage this with your surgeon.

John L. Burns Jr., MD · Answer

I'd suggest a lift and fill facelift.  You have a decent amount of laxity.  Addressing the deep plane or SMAS needs to be done.  I'd do a SMAS stacking to add more malar volume and fat transfer to replace volume in your mid face and to further blunt your deep nasolabial folds and marionette lines.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here !My answer will be based on the limited information and pictures provided , for a personalized and detailed plan please consult with a plastic surgeon in person.from your pictures you it looks like you would benefit from a mid-face and a lower face/neck lift, this can be coupled with some fat grafting to replace any lost volume and improve skin quality. Nonsurgical modalities are unlikely to give you long term effects that would be satisfactory.I hope this helps, best of luck!

Gregory S. Keller, MD, FACS · Answer

While a consultation is necessary to make a recommendation, the only procedure that can lift your cheek (mid-face) is a deep plane facelift with a mid-face lift.  Other procedures may look good for awhile, but won't look good over the long haul.

Jacob Tower, MD · Answer

Hello, hope you are well. Thank you for submitting your questions and photos. Based on the photos that you submitted, there is certainly enough soft tissue laxity/redundancy to undergo facelift surgery. You have accentuated nasolabial creases, jowling, and there appears to be laxity of the neck as well. A deep plane facelift is a great technique especially for addressing the midface (what you are simulating with your finger in the last photo). Your surgeon just needs to be careful with managing the hair around your ears. Good luck!

Cheers,
Dr. Tower

Cheers,
Dr. Tower

Michael I. Echavez, MD · Answer

An alternative treatment to a facelift would be replacing the volume in your cheeks using a filler.  This would make your face appear less tired and provide rejuvenation to your face.  There are a variety of fillers that could be used in the cheeks.

Warren Schutte, MD · Answer

Hello, it is very normal to see the signs of dermal and tissue aging at 46 y/o, especially as a lean runner. It is likely that you are too early for a facelift. It is important that your surgeon assess your neck and lower face to assure that you have enough skin laxity to ensure that a facelift would provide a robust result. I would recommend Ablative Laser work with skin coring, the UltraClear is a great technology. This will allow the reduction of skin laxity and provide a full face and neck laser treatment to boost collagen production (keep the dermal layer plump and youthful) and skin resurfacing (improve fine lines/rhytids/texture/pigmentation).

46, generally look very tired, suggestions on facelift procedures? (Photos)

Answers (13)

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