Skin laxity and volume loss in my face post menopause and weight loss - Lower facelift candidate? (Photos)

Question

48yo female 159cm and 65kg, postmenopausal due to oopherectomy age 38 and Aromatase inhibitor treatment (aggressive breast carcinoma). Ive noticed skin laxity and volume loss in my face post menopause , wprsening with recent 20kg weight loss. I feel that my face looks drawn and tired, and my neck looks ‘older’ than 48. I do clench my teeth. Have tried masseter botox (helped the clenching but made jowls more noticeable), skin needling, lasers. Always use sunscreen and good skincare. Drink water and get adequate sleep - but feel I look drawn and tired. Am i a candidate for lower face and neck lift? How long do results typically last if weight remains stable? It is significantly impacting my self esteem. Thank you

Frank Agullo, MD · Answer

Yes. You are a candidate for a lower facelift. The estrogen story makes the plan easier to map, not harder. Aromatase inhibitors strip what little soft tissue support you had left, and the calendar speeds up.

The lift has to do something specific. In my hands a deep plane on a 48-year-old in your situation pairs with fat grafting in the same OR. Cheeks, temples, around the lips. Pulling tissue without volume gives you that windswept look. Skin work usually rounds it out. CO2 either at the same time or a few months after.

You are an excellent candidate. I recommend a deep plane plus extensive fat grafting plus a Profractional and Micropeel pass and repeated it three months later. You will look like yourself, just 10-15 years younger.

Two consults with surgeons who do deep plane regularly. Bring photos of yourself from age 35.

#StayBeautiful,

@RealDrWorldWide

Gary M. Horndeski, MD · Answer

You are an excellent candidate for a face and neck lift.  This will improve your jowls as well as your marionette deformities.

Best Wishes,

Gary Horndeski, M.D.

Semih Yildiz, MD, FEPOBRAS · Answer

A lower face and neck lift may help jawline and neck laxity in someone with your concerns, but it would not correct all volume loss or a drawn appearance by itself. Photos are helpful, but an in-person exam is needed to assess skin quality, jowls, neck bands, facial volume, and the effect of clenching or prior masseter Botox.
Because of your breast cancer history, oophorectomy, aromatase inhibitor treatment, and recent weight loss, I would want your weight stable and your medical or oncology team comfortable with elective surgery. Results often last years, but aging and weight changes continue, so a balanced plan may include conservative volume restoration or skin treatments as well.

Mehmet Ozdemir, MD · Answer

Given your medical history and recent 20kg weight loss, you are an excellent candidate for a lower facelift and neck lift , as these procedures specifically address the structural laxity that non-surgical treatments like Botox or lasers simply cannot fix. The "tired" look you’re describing is likely due to a loss of deep fat pads and a shift in the underlying SMAS layer, which was further accelerated by early menopause and aromatase inhibitors both of which impact skin-firming collagen. Interestingly, your observation about masseter Botox is spot on; by relaxing the muscle that provides structural "tenting," the skin often drapes more heavily over the jawline, worsening the appearance of jowls. A surgical lift would physically reposition these deeper tissues to restore a defined jawline and a smooth neck, with results typically lasting 10 to 15 years provided your weight remains stable. While your journey with breast carcinoma has clearly been a significant battle, seeking this procedure to align your external appearance with your inner vitality is a wonderful way to reclaim your self-esteem.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, you are a good candidate for a lower face/neck lift. There are many facelift techniques and not all deliver the same result. Analyzing your photos, it seems that you have sagging and deflation of the midface, significant jowls, an elongated upper lip and fat loss in the temporal areas and lips. I believe that a deep plane face/neck lift will address these by releasing all the retaining ligaments to give you a natural non-pulled look with an upper lip lift (incision hidden in the upper lip/nasal junction) and fat transfer to the deficient areas. See a board certified plastic surgeon experienced in facial rejuvenation for an in person consultation/evaluation. Good luck.

Carl Truesdale, MD · Answer

Thank you for your question and for sharing your photos and medical history. Given your history of early menopause following oophorectomy and aromatase inhibitor treatment for breast cancer, it is wonderful to hear that you are doing well, and I want to congratulate you on your continued health. Based on what I see, you appear to be an excellent candidate for a deep plane face and neck lift. This procedure lifts and repositions the deeper facial and neck tissues while removing excess skin, particularly under the chin and along the neck, to create a more defined and youthful contour. Performing facial fat transfer at the same time would be highly beneficial, as it restores volume that has been lost in key areas of the face that contribute to a youthful appearance. Fat transfer can also help improve overall skin tone and texture, enhancing the final result. If you are in good health and within about 10 pounds of your goal weight at the time of surgery&mdash;and able to maintain that weight afterward&mdash;the results of a facelift can typically last 10–15 years. This surgical plan will help you achieve the aesthetic goals you desire. Thank you for your question.

Milan Doshi, MS, MCh · Answer

Hi Alime78From your photos, you do appear to have lower face laxity, early jowling, neck skin looseness, and facial volume loss, which can be worsened by menopause, weight loss, and reduced soft-tissue support. You may be a reasonable candidate for a lower face and neck lift, often combined with volume restoration such as fat grafting for a less drawn appearance.
A facelift/neck lift can improve the jawline, jowls, and neck contour, but it will not stop aging. If your weight remains stable, results commonly last 7–10 years or longer, depending on skin quality, genetics, and lifestyle.
Given your breast cancer history and aromatase inhibitor treatment, medical clearance and careful planning are essential before surgery.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

Foti Sofiadellis, MBChB, FRACS (Plast) · Answer

Based on what your images you appear to be a good candidate for lower face and neck lift surgery, and I would warmly encourage you to arrange a consultation so that suitability can be properly assessed in person.
Significant facial volume loss due to aging combined with a 20kg weight loss, creates exactly the kind of changes that facelift surgery is designed to address. Non-surgical treatments such as skin needling, lasers, and botulinum toxin are not designed to correct at a foundational level.
Regarding longevity of results: in patients who maintain a stable weight post-operatively, lower face and neck lift results typically last between 7 and 12 years before meaningful recurrence of laxity, though this varies with individual factors including skin quality, genetics, and ongoing sun protection.

Williams Bukret, MD · Answer

Based on your photos and history, you may be a reasonable candidate for a lower facelift and neck lift, but this should be confirmed with an in-person examination.

After significant weight loss and hormonal changes, the face often shows two different problems at the same time: skin and soft tissue laxity, and volume loss. A facelift or neck lift can improve laxity along the jawline, lower face and neck, but it does not automatically restore volume. In many patients, the best plan combines structural lifting with selective volume restoration, such as fat grafting, when appropriate.

Botox, skin needling and lasers can improve skin quality, texture or dynamic wrinkles, but they will not reliably correct jowling, neck laxity or descent of deeper facial tissues.

Because of your history of breast cancer treatment and aromatase inhibitor use, your surgical plan should also include proper medical clearance and coordination with your treating physicians. That does not necessarily prevent surgery, but it makes careful planning important.

In terms of timing, I usually prefer patients to be at a stable weight before surgery, ideally for several months, because further weight changes can affect the durability of the result.

A well-planned facelift and neck lift can last many years, but no procedure stops aging. The goal should be a natural, stable improvement — not an over-tightened look.

An in-person consultation with a board-certified plastic surgeon experienced in facial rejuvenation would be the best next step.

Best regards,
Williams Bukret, MD
Plastic Surgeon

Skin laxity and volume loss in my face post menopause and weight loss - Lower facelift candidate? (Photos)

Answers (9)

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