36 with jowls and smile lines, I don’t want fillers- is a facelift my only option? (Photos)

Question

I’m 36 years old and very unhappy with the way my lower face has aged; what feels like prematurely. I want to remove the lines around my mouth as best as possible; as well as give my lower face some lift. I told myself I would wait until I was 40 to have a facelift of any kind; but now I’m wondering if I can wait that long or if it would be better to act preventatively. Is microneedling (not rf- don’t think I can afford to lose any volume) enough to hold me over for a few years and treat the lines effectively? Is it better to act preventatively and fer a facelift sooner rather than later? How many facelifts can one hsve in a lifetime? I don’t want to use fillers- what are the best options for me to achieve my goals ?

Jeffrey Lisiecki, MD · Answer

I see patients like you all the time!  In your mid to late 30s and could anatomically have a facelift but aren't ready for one quite yet and want to try to hold off for a couple of years if possible.  While you are seeing the beginning of tissue laxity, part of what you are seeing is also fat volume loss in the face.  You also have a relatively small chin which is adding to this.  Facial fat transfer can restore volume and structure to your face and soften some of the lines and hollows you see.  Chin augmentation either with the fat transfer or potentially with a small implant would also help.  Microneedling is great for skin texture but won't make a big difference in the folds and hollows around your mouth.  I hope this helps!

Jeffrey M. Darrow, MD · Answer

Your concerns must be addressed by 2 methods.  The lines around your mouth will respond best to microneedling, which improves the quality of your skin and your lower face would be best treated by a mini facelift which addresses any excess quantity of loose skin.  At 36 years, your skin strength and elasticity should be excellent so your result should be long lasting, which may lead you to move forward now with both procedures done at the same time, so you have a single recovery.  Some patients have multiple facelifts, which need to be performed with nuanced attention to maintain a natural result.  Best wishes.

Ali Riza Öreroglu, MD · Answer

To provide the most accurate recommendation, an in-person examination is necessary. At 36, early jowling and smile lines can sometimes be managed with non-surgical treatments, but since you prefer to avoid fillers and want a noticeable lift, a deep plane facelift is likely the most effective solution. Microneedling can improve skin texture and stimulate collagen production, but it usually isn’t sufficient to provide significant lifting or correct deep lines, especially around the jowl area. Taking preventive measures is a good idea, but that doesn’t mean you need to rush into surgery; regular skincare and mild treatments can help maintain your skin’s health in the meantime. Most patients can safely have 1-2 facelifts in a lifetime, depending on their skin quality and healing capacity. Additionally, I recommend a chin implant to strengthen your jawline and create a more youthful and balanced facial contour.

Alejandro Nogueira, MD · Answer

Fillers are very dangerous and actually do not solve your problem, forget about them, absolutely.

A facelift may seem your solution at first glance: you have lower face, peribuccal, jawline and upper neck flaccidity... hence... deep plane facelift. Wrong.

Pay attention, you don't have overall facial or cervical flaccidity, cobra neck, platisma bands, etc, you have a sagginess issue around your chin, this has to make us think about the common denominator of all these issues.

People born with underdeveloped chin, in your case severely in disproportion related to the soft tissues and the rest of the facial skeleton, have poorly stretched lower face and upper neck soft tissues, leading to very early signs of aging. Solution is an autologous augmentation genioplasty, multidimensional, with bone grafting interposition; chin implants are very problematic and actual unable to stretch all the tissues deserving action on them, moreover fail to provide vertical increase.

Seek the advice of a surgeon with experience in multidimensional augmentation genioplasty using iliac bone grafting; stay away from step or spacing augmentation, synthetic material as spacer, fillers, etc, and of course don't you get a facelift, you'd ruin your face, that's of the elderly ;)

Michael P. Morrissette, DDS, FACS · Answer

It appears that you have lost some fat volume in your face, or perhaps have always had a thin facial appearance. In either case, a treatment option to restore facial volume and improve contour and definition is facial fat grafting. We take fat from the abdomen, buttocks, or thighs and inject your own fat back into the facial areas that require more volume. The appearance and feel are all natural, and unlike fillers, the fat can remain as much as 30-70%. The recovery is rapid, and there is minimal downtime and swelling because there is no foreign substance in your body. The procedure is performed in the office with sedation anesthesia.

Young Min Im, MD, PHD · Answer

You're curious about facelift surgery, let me explain!
There is no fixed or “ideal” age for facelift surgery. The appropriate timing depends on the patient’s desired improvements, current facial condition, and the realistic outcome that can be achieved.
Once sagging begins, the skin will naturally continue to lose firmness over time, and unfortunately, non-surgical treatments like fillers cannot provide the same results as a surgical lift.
Fillers are primarily used to restore volume to hollow areas, but they have limited ability to lift sagging skin.
A facelift, on the other hand, isn’t something limited to a certain number of times in life, it depends entirely on the condition of the face at that moment. In fact, many younger patients are now choosing to undergo facelifts to maintain a youthful appearance before significant aging occurs.
The degree and pace of aging, including how much the skin sags or stretches, are important factors in determining whether surgery is appropriate.
If you're hoping to look younger, it may be better to act sooner rather than later, reversing signs of aging at a younger age often leads to more natural-looking results that are easier to maintain over time.

Muhsin Yilmaz, MD · Answer

At 36, these concerns are more common than you might think &mdash; genetics and facial anatomy play a big role. Microneedling can improve skin texture but won’t lift deeper tissues or fully treat lines. Since you’re avoiding fillers, an early mini or deep plane facelift could be a preventative and natural-looking option.
Most people can safely have 1–3 facelifts in their lifetime, and earlier procedures often delay the need for major surgery later. A proper facial assessment would help determine the best path for you.

Darryl J. Blinski, MD · Answer

Your questions very interesting and your photo are presented nicely. I recommend a mini face neck lift with muscle plication in combination with Endo laser and possible ALOCLAE injection in combination approximately 12.5 cc. Fee $10,000-$12,000. Best of virtual consult with.

36 with jowls and smile lines, I don’t want fillers- is a facelift my only option? (Photos)

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