Looking down at a mirror vs. looking up at one, does it really indicate lax tissues?

This is an interesting question. The same gravitational forces that pull on our skin and fat and cause our faces to sag also work more favorably on us when we lie on our backs. That's true in your 20s, 30s, or even into your 50s and 60s. The effect, of course, becomes more pronounced as we age. A facelift counters these effects by lifting the tissue and muscle and creating new suspension structures to keep them elevated, whether you're standing upright or not. If people say you look 20, I doubt you're ready for any aesthetic procedures, but your observation is very astute!

Dear Mike_MThank you for your question!  You are correct- the question is what are the precise changes you are looking for and are there other ways to achieve your goals such as fillers , skin tightening devices and. botox.With Warm Regards,Trevor M Born MD

Pretty much everyone will appear better looking at a mirror when they are on their back versus standing.  When people are on their back, gravity affects the face differently than when standing and thus produces a more youthful appearance for most people.  

Because gravity pulls down, a patientwill always look worst when looking down in a mirror.There are other factorsaffecting this. As aging continues thesetest becomes more significant. Manybelieve that by laying down and lookingup in the mirror will provide a general ideaof how a face lift will look. I advise patientswhen evaluating their faces do it in a verticalposition like sitting in front of the mirror. Lookingdown in a mirror can be deceiving and discouraging.Best Wishes. 

It is absolutely true that certain facial positions are more flattering than others.  The same can be said for your body.  The trick is to promote the good and avoid the bad as much as possible.  That being said, lying on your back and looking into a mirror has long been a layman's test of the need for a facelift since it eliminates the affects of gravity.  Looking down into the mirror exaggerates the affects. But don't take that as a need for a facelift.  Skin laxity becomes apparent in most people in their 20s, but it is rarely visible unless exaggerated by positions, as you have.  The best way at allay your concern is to visit a reputable board certified plastic surgeon who could evaluate you for premature skin laxity.  Chances are you are simply being fooled by an unfair representation of yourself.