What procedure is best for me? Should I consider a facelift at my age? (Photo)

Hello I am 43 years old. Feel like I'm 23. Noticed fine lines around my eyes in my late 30s. And around 40 the skin under my eyes became more hollow. I do get Botox injections for my eye wrinkles. And the area between my eyebrows. But now my main concern is the loss of volume in my cheek, under my eyes has gotten worse.. And the jowl area.. My neck doesn't seem as tight either. Should I consider a facelift at my age? What are my other long term options?

Doctor Answers 31

Loss of volume of the cheek = hollowing of the eye socket rim

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Hi Tonyarl72,

The facelift will help the jawline area and a little bit on the neck also.  The loss of volume of your cheek is really caused by the hollowing or loss of fat around your eye socket.  

In your instagram filtered photos with makeup, the lighting, make up, and filter causes a blending of the upper cheek to the lower eyelid.  Essentially your lower eyelid itself becomes your upper cheek.  

A facelift will be able to lift the cheek fat pad high enough to hide the hollow around the eye socket.  A simpler and more elegant solution is to replace or revolumize the junction between the lower eyelid and upper cheek.  This solution appears to be a cheeklift, but the more the lower eyelid is "hidden" the higher the cheek appears to be.  The cheek did not really "fall down" 1/2".  The exposure of the rim of the eyesocket with very gradual fat loss over many years makes the cheek appear to deflate and sag.

The first two photos you posted show a very nice neckline and jawline.  I suspect backe on the the bedspread, that you are laying on your bed which helps to "drape" the facial and neck skin backwards and would likely be the result of a lower face and necklift.  The 3rd photo you also appear to be laying on your back  which helps to make your jawline more heart shaped.  Notice that even though gravity is not involved with that photo, the loss of volume of the upper cheek/hollowing of the eyesocket rim looks about the same as the 4th photo.  The 4th photo does show some jowling which is sagging of skin and fat along the jawline.  This causes a squaring of the jawline on a front view.  A lower facelift/mini-facelift would help you to look more like the 3rd photo, by lifting and tightening the deeper tissues of the cheek and remove some of the excess skin.  

Lastly, Your upper eyelids look great.  I like how the eyelid fold is parallel to your eyelash line, and the amount of eyelid that you have showing is probably not much different from when you were in high school.  This is why your make up photos look so authentically young.  Other than the nice neck and jawline, there is so much brightness that nicely frames your almond shaped eyes.  Don't let anyone talk you into an upper eyelid skin removal surgery to make you look "younger."  Showing more eyelid may make you look "different" (think 2014 Rene Zellweger) but not necessarily younger.

I hope this helps.  Good luck on your facial restoration journey!


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

My Recommendations for the Aging Face

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Thanks for submitting your question and pictures. Fullness in your lower eyelids is best addressed with a blepharoplasty. Fat can be removed or repositioned. The tear trough, which is the junction between your eyelid skin and cheek skin, can be improved by fillers as well. Facelifting will improve any jowls that you may have developed and will also help tighten your neck. Facial volume, especially in the cheeks, nasolabial folds, and marionette lines is best addressed with fillers.

You should speak with your physician about fat transfer to improve volume loss. It will give you the best long-term volume improvement and can be done with or without a facelift. As everyone ages, there is both volume loss and sagging that occur, so adding fat transfer to a facelift procedure will give you the best results. You seem to be doing a good job of education yourself on your options. Good luck with your decision!

Facelift or not.

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Thanks for a good question. Whilst your age is 'young' to consider facial rejuvenation surgery you do show some signs of ageing in the mid and lower face. These may be masked with injectable volumisation in the short term along with good skincare. I suspect as the aging process continues you will be a great candidate for a facelift.  From a couple of your photos I would offer you a facelift as long as you were aware of the limitations of surgery and that at 43, it may be that around the menopause or just afterwards you will be looking at revision surgery to maintain your youthful looks. Long term, avoidance of known aging factors such as sun exposure, smoking and dehydration are really important. 

What Age is Best for a Facelift

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A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift.
During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.
If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

If you are deemed a candidate, Lite-lift™ may be an option for you. Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. The LiteLift™ is an innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself which benefits many male patients. The goal of the #LiteLift is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.
The technique requires limited incisions and takes a vertical lifting approach, in contrast to the traditional facelift, which requires extensive incisions and lifts or pulls the face towards the ears horizontally. The modern techniques used allow us to perform most LiteLift® procedures in the office under local anesthesia. Also, removing the risk of general anesthesia opens the door for more people to pursue facial surgery. All too often people do not move forward with undergoing the desires facelift surgery due to their overwhelming fear of the risks associated with general anesthesia.

This is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. They also have a face and neck line beginning to sag, but whose skin has elasticity and whose bone structure is well definedOlder patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™.

What procedure is best for me? Should I consider a facelift at my age?

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Although the best recommendations would come after an in-office evaluation it appears that the most important area to be rejuvenated would be your lower eyelids.  

A lower blepharoplasty using only the fat repositioning technique would help eliminate your "tired" appearing eyes.  This procedure would decrease the "puffiness" while simultaneously smoothing and filling the groove and hollowness under your eyes.  You may need fat transfer as well but that would be determined from the in-office evaluation.  Additionally a fractional CO2 laser may be discussed to improve the quality of your skin and eliminate brown spots, uneven skin tones, and wrinkles.  

For mild laxity in the lower face and neck Ultherapy can be performed but for improved tightening a lower face neck lift may or may not be recommended based on the in-person evaluation.

The attached link provides more information.

I hope this helps.

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 70 reviews

Should I Have a Facelift?

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Your lower lids are out of sync with the remainder of your face. Yes, there is also facial volume loss which can be restored using injectable fillers or your own fat (facial fat grafting). For the best results of your lower lids, I would recommend a lower blepharoplasty with fat repositioning: this will reduce some of the puffiness, fill in the tear trough and tighten the skin. 

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 51 reviews

Facelift at 43 yo

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The most obvious aging signs when looking at your photos, are your tear troughs / circles under your eyes.  A lower lid blepharoplasty with fat grafting is what I would recommend.  As far as jowl areas, only on one photo I can see minimal sagging.  You may want to consider a mini facelift.  Fillers can be beneficial for around your mouth.  Make sure you find a Board Certified Plastic Surgeon in your area, hope this helps.

What can I do to make my face look more youthful, face lift or filler?

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You have the being stages of volume loss in your mid face and temples which is consistent with your age group.

Your choices are volumization with fillers, or a face lift with autologus fat grafting.

The lower central photo you have posted shows a striking jaw line. You however, do not comment on how recent the photo is. There are no good lateral view photos to assess your neck line.

The most obvisous loss of volume in your face is under your eyes and your pre-jowel sulcus.  Fillers could be used to improve this areas and buy you time before a face lift.

If your neck is lose, you have the time for recovery and the money, a face lift, lower lid blepharoplast with cathal suspension and autologus fat grafting would give you a nice result.

You  have great bone structure. With a face lift the result will be more dramatic than fillers and last longer.

After a face lift not only will you feel 23 you will look 23, based on your lower photo.


Jon M. Grazer, MD, MPH, FACS

Plastic Surgery

Newport Beach, CA

What procedure is best for me? Should I consider a facelift at my age?

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A facelift will not address the changes that are bothering you. Dermal Fillers like Voluma and Perlane can restore mid face volume.Transconjunctival Blepharoplasty with Arcus Marginalis release and Fat grafting can improve your eyes and improve the hollow area beneath the lids. Please read the following link

When should I consider a facelift

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In general, a facelift (or rhytidectomy) is indicated for patients with complaints of excess loose or wrinkled skin in the neck, excessive or drooping jowls, deepened naso labial folds, and sagging of the cheek tissue.  Low brow position, excessive or wrinkled eyelid skin, excessive upper lid tissue and bags under the eyes may require other procedures at the same time (brow lift, upper and lower lid surgery).  Fine lines around the mouth and eyes may ultimately not be improved with these surgeries, but may benefit from resurfacing procedures (chemical peel, laser treatments, etc).

Patient age should not ultimately be the determinant of whether a patient is "ready" for these procedures, but rather patient complaints and the ability to adequately address those complaints surgically.  Based on some of your pictures, it appears that you are showing signs of excessive jowling and lax neck skin and plastysmal banding (vertical bands in the neck related to the underlying muscle).  These issues could be addressed and improved with face lift surgery.  It is best to consult with a board certified plastic surgeon to determine what interventions may be indicated to achieve a desired post operative result.

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.