What to do? When to do it? (Photos)

I wanted to be able to respond to the Dr. responses and add I had Co2 Laser 1 year after stopping smoking when I was 45. My lips bother me the most at this moment but I know I need a face lift Lip lift 22mm now and I am not sure if I need upper eye, brow lift or both. As you can see in my 45 year pics I am no worse but I'm 53 and feel like if I do it now when will I have to do it again? The Laser lasted about 6 years, should I stop botox before consult. It is time

Doctor Answers 20

What to do? When to do it?


Thank you for your question and photos. you are a good candidate for Spiderweb and fat transfer to the face. 

Facial aging

You have many options which will be best determined after you meet with a PS and specifically go over your areas on concern. Timing depends on your schedule. There is no reason to stop botox.

Candidate for a Facelift

If you feel that your face does not reflect how young you feel on the inside, a facelift may be the solution to help you look and feel younger. During your consultation, your doctor will evaluate your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure. Based on this evaluation, he/she will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. Your doctor should make sure you have a full understanding of what results to expect.Always insist on a board certified surgeon!

Many options

You have many options but the first things I can see center around the eyes and the mouth.  For your eyes I favor a brow lift.  Around the mouth a great answer would be for filler preferably fat. Fat transfer to the nasal labial folds,  marionette lines and upper lip.   A second CO2 laser treatment is nice as well but third on my priority list of suggestions.  

David Q. Santos, MD
Bellevue Facial Plastic Surgeon
4.3 out of 5 stars 21 reviews

Facelifting #woundhealing #cosmeticsurgery #BOTOX #tmbcosmeticsurgery

Dear Donna LouisvilleThank you for your questions and photos! Stopping Botox is a good idea.  The plan is difficult to detail- lip shortening and a facelift are good procedures to consider - but an in person exam is most important in determining exactly your goals and the ideal procedures.With Warm RegardsTrevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 102 reviews

5th decade is ideal for facial rejuvenation

Thanks for the pics and question.  Aging has many facets but the CO2 laser resurfacing continues to support your skin texture and tone.  Analyzing from top to bottom: upper 1/3rd (from hairline to bridge of nose) your brow appears to be at an ideal position, although Botox may have contributed a lateral lift.  Today's forehead rejuvenation standards avoid excessive space between the brow and upper lid (dear in the headlight appearance). The upper eyelids could be conservatively lifted under local anesthesia, as a stand alone procedure.  Middle 1/3rd (from bridge of nose to base of nose) show deflationary changes, which may be improved with SMAS facelift+/- fat grafting.  Lower 1/3rd (from base of nose to jaws & neck) has the greatest needs: flattened upper lip (try conservative lip lift), radial lip lines, mandibular jowls, marionette's lines, submental fat deposit,  "turkey neck".  When you hate your neck and jowls, start interviewing PS.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 56 reviews

Time to DO it is NOW

If you know for CERTAIN you want a facelift and from the pics it does look like you may benefit, I would do it sooner than later.  As we age, we tend to age faster when older.  Having facial surgery younger has the added benefit of LONGER result and you can enjoy the results EARLIER.  I would stop botox 3 months prior to your consultation to allow examination of the face at "baseline".

Johnny Mao, MD, FACS
Orange Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

What to do? When to do it?

Hi, from the photos eyebrows appear to be in the proper position.  The cheeks are flat anteriorly (in the front), there is excess fat below and in front of the cheeks and "jowls" are present.  These factors combine to create a rectangular shaped face.  Following the beauty principles outlined in my book on face and body beauty, 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.I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  If you have "jowls” these are sagging facial tissues and an 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 facelift is the minimally invasive, short incision 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
  • 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
  • excess skin removed
  • 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
4.6 out of 5 stars 24 reviews

Next step in Face Rejuvenation following CO2 laser tightening: Non-surgical, Minimally Invasive or Surgical?

Dear Donna Louisville:Thanks for sharing your photos! You look wonderful and certainly not your age. The CO2 laser did a wonderful job. Your best next step is revisit your initial surgeon or consult with a Board Certified Plastic Surgeon skilled and talented in:
  1. non-surgical facial enhancement to maintain and improve your investments such as: fillers, Botox, lasers and skin health
  2. the newest techniques in minimally invasive facial enhancement such as ThermiTIGHT  for your lower face, jowls and neck, Silhouette InstaLift to lift the jowls, cheeks and temporal brow
  3. surgical skin redraping and soft tissue lifting such as platysmaplasty of the neck and smasplasty of the cheeks and jowls. 
Based on your last photo, consider:
  • Upper eyelid blepharoplasty
  • Silhouette jowl, upper cheek and brow lift or cheek fillers
  • ThermiTIGHT for upper lip, lower cheek, jowl and neck skin tightening
  • Obagi ZO Skin Health for continuous skin stimulation
  • nasal tip rhinoplasty
I hope this is helpful. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 69 reviews

Mini-lift, upper blepharoplasty

Thank you for the photos and for sharing your story. In general, I recommend that my patients start slow and add bigger procedures when appropriate aging changes have become obvious. This helps to avoid an overdone look and allows them to manage the recovery. In your case, you have already done a lot of the smaller things... and it may be time for a mini-lift. This will be the best way to tackle the jowl that is developing and to reposition the cheeks to a more youthful place in the upper midface. Adding an upper eyelid lift will make you look less tired and more open. As for the lip lift, this is a great procedure when performed in the right patient and in a fairly conservative manner. I do it regularly, but I always advise patients that some aftercare for the scar is essential. Best of luck moving forward!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 94 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.