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

Simply, despite being late 20s who people say looks 20, I much prefer how my face looks when laying down on my back and looking up at a mirror, vs standing and looking straight. It moves the fat pads up and out, smooths transitions, improves mouth/jowl area too. Is this likely somewhat true for almost anyone at any age, or does it really always mean something? I ask because I know it is fairly well known and a test that the former can show what a face-lift would help achieve. That bugs me!

Doctor Answers 12

You're Seeing Gravity's Effects

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!

Toronto Plastic Surgeon
4.8 out of 5 stars 59 reviews

The mirror test you mention

is only used to help patients appreciate what a facelift could do for them.  It is not a test to diagnose lax tissue.  But if you're appreciating the effects of aging and are ready to dive into the realm of cosmetic surgery, there are plenty of surgeons near you with whom you can schedule a consultation for simpler things that could be done t help with rejuvenation... at your age, they should almost all be minimally invasive unless you have some tissue disease that results in more laxity.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Facial skin laxity

Hi Mike,
You make a very keen observation with your face when laying down.   Today, with ipads, when we lie down and look at our screens, we will catch glimpses of our face.  Yes.  You are noticing the effect of gravity from different angles.  Does it mean anything?  Not in your 20's.  Eat well balanced meals, exercise, drink plenty of water and if you want to look into what can be done to prevent aging, then schedule a consultation with a facial plastic or plastic surgeon.  There are many noninvasive devices, but when you sit down with a physician and walk through what your concerns are, then you can develop a plan to slow and reverse the aging process.  Best of luck Mike!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon

Facial appearance on back versus standing

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.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews


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.   

R. Scott Yarish, MD
Houston Plastic Surgeon
4.4 out of 5 stars 31 reviews

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

The test that you have performed shows the effect of gravity.  All of us have some laxity of facila tissue or else our facial expression would be severly limited.  Your slight laxity is normal

Fred Suess, MD
San Francisco Plastic Surgeon
4.4 out of 5 stars 7 reviews

Facelifting #aging #facialrejuvenation

Dear Mike_M

Thank 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

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

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

You are correct, that gravity can change the appearance of any ones face, even one who is younger with minimal skin laxity.  Even the direction of lighting can have an apparent effect.  Down lit ceiling lights will create shadow effects that disappear with softer under lighting. If you are in your late 20's it is probably too early to consider surgical facial rejuvenation surgery.  However, you may be a candidate for more minor treatments such as Botox or injectable fillers.  Check with a board certified plastic surgeon for options which may be reasonable in your case.  Best wishes, Dr. Lepore.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.9 out of 5 stars 49 reviews

I look better laying downS

Many patients feel they look their best laying on their back, even those patients who have undergone a facelift.  This is due to gravity's effect. A facelift is generally not recommended in your twenties.  Some may benefit from filler at an early age which is temporary.

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Look Best Laying Down

We all look best laying down & looking up!  

It sounds like you may need some volume in your cheeks.  Try smiling in a mirror & see if the volume that is pushed up looks better to you.  This simulates the effect of a filler like Voluma.

I cannot imagine that in your late 20s a facelift is necessary- post some pictures!

Enjoy your youth!

Melanie L. Petro, MD
Birmingham Facial Plastic Surgeon
4.7 out of 5 stars 28 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.