Facelift/lower facelift at 40 (my neck skin is so saggy)? (Photos)

I see the loose skin you are talking about, and your skin has been through a lot to warrant a procedure. You appear to have too much loose skin to consider a noninvasive procedure such as Ultherapy or microneedling with RF to tighten the skin, and I do not think you would be happy with the results, which are minimal compared to what surgery can produce. There are many things that contribute to ageing of the face: genetics, sun exposure, smoking, weight gain and weight loss, diet, exercise, etc. One person might have signs of ageing at 40, while another 40-year-old might not have any of these signs. As a board certified plastic surgeon who regularly performs facelifts and neck lifts, I am often asked “am I too young for surgery?” Certainly, younger skin responds very well to surgery, and having the procedure (with your specific anatomy) at 40 will give you a very long-lasting result. If you came in at 70 with very loose skin and jowling, an additional factor of loss of skin elasticity and integrity due to age would be present, since older skin does not respond as well as younger skin. I would absolutely study the results *very carefully* of whichever surgeons you are considering. I am unfortunately often consulted to help revise subpar facelifts and neck lifts that leave patients with visible scars easily seen, some with “railroad track” scars caused by quick and messy closure techniques, staples, inappropriately wide suture material etc. Make sure that the results of the surgeons you are contemplating illustrate patients who look extremely natural postoperatively, not pulled or fake. One note about this: if the SMAS (the submuscular aponeurotic system) and the skin on top are treated as one unit (which happens in quick, inexpensive surgery), you will see the telltale signs of “bad” surgery, such as pulled corners of your mouth and the dreaded “wind tunnel” look. I would suggest having a few consults with board certified plastic surgeons. Keep in mind that no two answers will be exactly the same! In the end, it is truly up to you to decide when it’s right for you to move forward.

A lower face/neck lift under local would give amazing results, especially combined with Morpheus8/PRP/and TCA peeling of the face, neck and chest. It is painless and easy to undergo.

I see and understand your concern and I'm here to share with you what I would recommend. Given that there is so much extra skin I would recommend a lower face and neck lift. The reason for this being that any sort of non-surgical treatment is just not going to give you a substantial result that you may not even be happy with. It is important to consider the cost-benefit ratio when deciding between surgical and non-surgical procedures as well as considering the health of your skin. At your age your scars will heal beautifully and this would be a result that can last you 8-10 years. Going forward, I would recommend you to complete multiple in office consultations with board certified experts to discuss your ideal aesthetic goals. This way, they can better assess your face and create an ideal treatment plan for you.

Best of luck,
Kian Karimi MD, FACS

Of course, a consultation is necessary, but it appears that, with your weight loss and loss of volume, the structures of the face, as well as the skin have sagged, and a lower face/neck would be best, even at your age. Picture also a trampoline that has been bounced on and stretched. Simply tightening in one direction such as posteriorly like a necklift, will probably not render the result that you want. It is helpful to tighten the trampoline in all directions. The upward pull that a facelift will give you, will also pull upward on the platysma muscle and skin of the neck. Try pulling upward on the face, and watch your neck. You will see some improvement from that upward pull alone. The good news is that, at your young age, your healing and regeneration capacity is great, so it is likely that you will get a nice result.

Thank you for your question and sharing your photographs.

In general, the pattern of skin laxity under the chin which is shown in your photographs benefits from a combination of neck lift and facelift. The placement of the scar for the facelift may be more advantageous in front of the sideburn rather than in the temple. This will allow more effective removal of skin excess from the area under the chin.

There is also some fullness under the chin which may benefit from direct access to the neck to reduce it. To understand better whether there is skin laxity only or volume excess under the chin you can look in the mirror when you are lying down completely flat. If the contour of the neck is very good, you are dealing with skin laxity. If there is still volume persisting when you are lying down, surgery would need to address it for best results.

The skin excess lower in the neck will be removed effectively through the scars behind the ears.

I would agree that you are on the young side for a facelift however given the skin redundancy I think you will be underwhelmed with the results of anything other than a facelift. My recommendation would be a lower face and neck lift. Best of luck!

Seek out a Board Certified Facial Plastic Surgeon who has extensive experience dealing with the aging neck and your answer will be apparent. A careful history and a methodical physical exam will likely reveal (at least from your excellent photos) that you are a sensational candidate for a face/neck tightening procedure of some type. Because your neck and lower face is rather slender and your jaw line is quite defined-I imagine that your choice of surgeon will lead to a fantastic result with a stand up home run well out of the park! Your anatomy as revealed in your photos would suggest that you would get a terrific redefinition of your lower face and neck....and a very happy patient !
Happy surgeon searching and good luck to you and your new neck/face !!!

if you want a dramatic change necklift/facelift, Implants and fillers will give you that. noninvasive will improve the area and facetite, threads, morpheus, and fillers can be used.  start at home dermarolling to tighten you skin, see emeragecismetics.com where we do free skincare consults daily and recommend emerageskin roller with anteageMD ampules daily (see dermarolling package).

With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel,  co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles.  You need a formal consultation, as the neck can be treated with a combination approach:
1. micro needling and lasers for texture
2. botox, disport or xeomin to help platysmal bands
3. intensif or fractora RF microneedling for crepe skin and lifting
4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds
5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening)
6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening
7. ultherapy and thermage for external tightening
8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness
9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production
see an expert for a full evaluation and treatment plan based on your individual situation and goals.
Best, Dr. Emer

I have many patients that received a facelift in their 40's. It really depends upon your expectations. The really determining factor is the platysma muscle in you neck. There no lasting minimally invasive procedure that will bring these muscle together. Seek in office consultations that will customize what alternatives are best for you. Sincerely,

Michael Kulick MD
San Francisco, Ca

Based on your photos you might be a candidate for a face and neck lift. However remember that wrinkling can be easily accentuated by twisting your head. All photo evaluations must be done with your head in the neutral position to determine the extent of the problem. Tissue redundancies are always created with head or chin flexing because movement must be accommodated once the head or chin position is restored. Even with that being said, you are likely a candidate and it’s best to go for a personal evaluation.