Surgical or non-surgical, very confused: blephoraplasty, facelift, fraxel, injectables or a combination?(photos)

Female 9 stone Height 5 ft 5 45 years old Fit, healthy No previous procedures I have bags under my eyes, I also have some loose skin under my neck, and it seems that my cheeks have lowered. What treatment will provide the best result? My concern is that if I choose surgery/surgeries, I may end up with a result that could have been achieved with a non-surgical procedure. I would be very grateful for your recommendations.

Doctor Answers 17

Surgical or Nonsurgical- Either Could Be a Good Option

The answer to surgical or nonsurgical is... yes. While there is nothing nonsurgical that will give you the results of a facelift and blepharoplasty, a combination of fillers would likely cause a noticeable improvement. You will not get as good of a result from a nonsurgical procedure but given how good things look, especially in the picture where you are smiling, it is likely that filler used in the cheeks as well as underneath her eyes would cause nice improvement. As in most situations, which way to go depends on your expectations.  Figure out In advance how good the result needs to be in order for you to be happy and you will know which direction to go. Good luck

Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Face lift? If not, what?

Thank you for asking about your face lift and blepharoplasty.
  • Neither injectables, nor Fraxel nor any other office treatment can produce the results of a face lift and lower lid blepharoplasty.
  • Nor can they produce permanent results.
  • With loose skin and excess low lid fat, your best result will be a face/neck lift and blepharoplasty.
  • Injectables will help to maintain the result by filling areas that surgery can't improve or adding volume as facial fat absorbs over time.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Many options for rejuvenation

great question! There are many options from which to choose in your case.  I would try fillers first and see if that gives you the results you desire.  If it does, great! If not, you consider subtle eyelid surgery and cheek neck lift.

Jeffrey Joseph, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Surgery is the gold standard

Hello:Thank you for your question.  We certainly have a lot of noninvasive options today.  Ultherapy for the neck, combined with fillers such as Voluma for the cheeks, Kybella to reduce fat under the chin, botox for wrinkles, and finally lasers and light based treatments for the skin.But surgery (facelift + neck liposuction + blepharoplasty) will give you the best and most long lasting results, without question.  Surgical results typically last for 10 years, and studies have shown that the earlier you have facial rejuvenation surgery, the longer it lasts and the better you will look. And I think your age is ideal.  Keep in mind also, that you may still want to visit your dermatologist for some "upkeep" after the surgery - such as botox and lasers.I would recommend getting a consultation with doctors who specialize in noninvasive treatments, and with at least 3 surgeons who specialize in facelifts.  Weigh your options and make an educated decision.  Best of luck!

W. Matthew White, MD
Manhattan Facial Plastic Surgeon
4.8 out of 5 stars 6 reviews

Surgical vs. Non-Surgical

There are some truly great improvements that can be achieved non-surgically. However, there is no non-surgical treatment that can lift loose skin either on the face or the eyelids. Only surgery can do this. Furthermore, the results from surgery are permanent while most non-surgical treatments will need to be continually administered. So, impossible to say what choice is right for you. Will depend on your desired outcome, budget and tolerance for down time. 


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 34 reviews

Customized procedures

Naturally there are so many options that it is easy for someone to get confused. The advice I would give to you really is to find a very reputable facial rejuvenation specialist and get their opinion. Most reputable surgeons will recommend a customized approach to rejuvenation and sometimes it does include a combination of therapies which may or may not include surgical and non-surgical options. For example, if someone has very wrinkled skin a lifting procedure may not necessarily address the wrinkling. And if someone has a considerable amount of volumetirc loss a lifting procedure would not address that. For this reason many doctors will combine procedures to address rejuvenation in the most natural way possible.

Edwin F. Williams, III, MD
Latham Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

Surgery vs. Non-Surgical Options

Thank you for your question! Yes, you can achieve very nice improvements with non-surgical options, such as hyaluronic acid fillers and CO2/Fraxel laser.  These results are not a permanent fix, which some patients prefer.  This allows patients to see if they like their results before surgery.  However, surgical options, a facelift and blepharoplasty, can offer a permanent result to the concerns you are describing above.  I would consult with a board certified, fellowship-trained facial plastic or general plastic surgeon, who specializes in the aging face.  He/she will perform a full history and physical examination, and 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 22 reviews

Find the right surgeon

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another. 
See the below link on some suggestions on finding the most qualified Plastic Surgeon for a consult.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews


For your case, there are many options. It all depends on how much recovery time you have, what are your expectations, how much you want to spend, etc. The best and long lasting results will be from a lower eyelid surgery, a face and neck lift. You can get fillers on the cheek area, and the lower eyelid surgery, the results will not be as good, but the recovery time is shorter, and finally they will not last as long. For some one who is afraid of the anesthesia or drastic changes, the fillers and lower eyelid surgery are the first option.

Juan Carlos Fuentes, MD
Mexico Plastic Surgeon
4.7 out of 5 stars 65 reviews

surgical lower blepharoplasty and face lift procedure

The primary goal of lower eyelid surgery is to remove the fatty  deposits located in the lower lids through a trans-conjunctival approach on the inside of the eyelids.  This rejuvenate still lower lids.  The primary goal of a lower face and neck lift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and removed fatty deposits located in the neck.  For more information  and many before and after examples of both procedures, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 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.