Mid Facelift, Mini Lift or Fillers for Marionette Folds and Slight Jowls at 37?

hello,i m 37 with quite ok skin quality(no deep wrinkles,few fine lines etc.),i always looked young for my age,however,in the last 2 years my face which was always quite round and a bit chubby(depends on my weight) start to look gaunt in the middle and the heaviness became more predominant around my mouth and jowls(plus the corner of my mouth are downwards)which makes me look older and almost "masculine".Which procedure would be the best option for me??

Doctor Answers 33

Face lift at 37?

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Dear missmagic73,

   I  have examined your picture carefully and here are my observations : Noticable jowls, hollow cheeks, deep tear trough grooves and downturned corners of the mouth.Fillers like Restylane can improve, but they are temporary and do not help the big picture outlined above. Fat injection are also limited in the total improvement. In my opinion, your best bet is a face lift based on the MACS lift technique ( developed in Europe by Dr Tonard from Belgium ). The procedure is very powerful because it uses deep sutures that lift the facial fat and muscles under the skin. It will do the followings for you : Fill the sunken cheeks by raising the jowls fat and famminising you face. Raise the corners of your mouth. Fill your tear trough groove and the hollowness under your eyes. Tighten up your skin. Be sure to select a board certified plastic surgeon who is experienced in the MACS lift technique.

                   Best of luck,

                                                Dr Widder

Mid facelift works for 37 year olds.

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As you can see from all the different answers, this is an art more than a science. But this is my experience.

A well done mid facelift (through the mouth, no scars) will correct gaunt look and lift the corners of your mouth.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Addition-Subtraction paradigm for facial rejuvenation

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I think some liposuction along the jowls and neck and fat grafting to the mid face would be a minimally invasive approach to improve the shape and volume distribution of your face.

A Mini Facelift is better than fillers for lower face and mouth laxity

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Although  soft tissue fillers work will to plump the Nasal Labial Fold and cheek I find them less helpful to improve laxity around the mouth and jawline. I think this is related to the fact that the mouth has less rigid tissue (bone) supporting it than does the cheek.

A Mini Facelift does a better job (In my opinion) tightening the mouth, lower cheek and jowl area than do filler injections.

You are young, with good skin, and a properly done Mini Facelift should give you an excellent result.

Note that it is not uncommon, after a Facelift, that you can benefit from Soft Tissue Fillers placed over the cheek and beneath the Nasal Labial Fold to improve over all Facelift results and facial rejuvenation.

Fillers Versus Facelift for signs of early aging

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Dear missmagic- as you can see from the answers there are no clear cut solutions for your issue.  The biggest issues I see from your photos are the jowls and indentation of the jawline just in front of the jowl.  This deformity is a characteristic sign of aging and very uncommon in people under 40.  Fillers could give you a temporary result but they could last up to a year, and you could avoid major surgery.  If you want to go for surgery then a lower facelift, not a midface lift, is necessary.  Each choice has pluses and minuses, but in general for patients your age I usually recommend starting out with fillers and other less invasive techniques before I advise the patient to have a face lift. Good Luck.

Mini-face lift or fillers

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Thank you for the photo.

A mini-face lift will give you a permanent improvement in the areas that bother you.

A mid-face lift will not correct the jowls.

Fillers are temporary and for these problems, disappointing at best.

You are beautiful. Early aging has squared your face a little.

You should be thrilled with a face lift result. Best wishes.

Another option for facial rejuvenation

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I think you got it right. You lost volume from your face and what you see now is the "skeletonization" of the face and developing a more angular, masculine look. The "chubby" look conveys youth. You are blessed with high cheek bones which gives you the inverted cone of youth. What you are experiencing is fat loss from the face. I personally would skip the temporary fillers, would not subject you to a facelift but do panfacial micro fat grafts to better balance and rejuvenate the face. I would not call it a stem cell facelift (this is more a marketing term than science). We know that fat injections are technique dependent and might need to have more than one session for the best results. How long does the fat last? If done appropriately, it can last many years. I have patients who are out over 7 years from the procedure and still have full cheeks and look great. As you see there are a lot of options. You need to find a board certified plastic surgeon who is well versed in all the surgical and nonsurgical options and is not a "one trick pony". Good luck, you should achieve great results since you have good bone structure.

Mid Facelift, Mini Lift or Fillers for Marionette Folds and Slight Jowls at 37?

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When I see a 37 year-old with downward turning corners of the mouth, marionette lines and hollow cheeks my recommendation is to proceed non-surgically with judicious and conservative use of fillers and botulinum toxin.  This can rejuvenate the face, raise the corners of the mouth and give a more feminine and youthful look.  I personally think that you should have conservative treatment at your age and avoid surgery until you're in your 40s or later.  Good luck and best wishes.

Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Member, Am. Society of Aesthetic Plastic Surgeons (ASAPS)
Beverly Hills, CA

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Jowls and Facelifts

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Jowls can be caused by loosening of the face and neck from aging. The jaw line softens into jowls and fine lines appear on the corners of the eyes, forehead, and face. To define the neck, a chin implant is recommended in younger patients and a facelift in older patients (over 40). A facelift addresses the folds and jowls of the jaw. Liposuction of the neck and a mini facelift can be performed in younger patients. More so, a facelift or neck operation can help boost confidence while returning a more youthful appearance. The trend in facelifts is to have surgery at a younger age.

Surgical and Nonsurgical Options for Marionette Lines and Nasal Labial Folds

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The treatment of facial aging should be individualized based on the patient’s aesthetic goals, anatomic findings and social situation.  No two patients are exactly alike and because of this appropriate treatment depends on the patients specific anatomic needs.  In your case, multiple options exist for correction of your problem.

A mini facelift would address many of your concerns.  This procedure would address skin laxity, jowls and nasal labial folds.  Unfortunately this would require a surgical procedure, significant expense, a recovery period and potential complications.

In someone who’s only 37 years old, a temporizing maneuver might be more appropriate.  In this case, injectable fillers might represent a solution to your problem.  This approach would need to be repeated at intervals, but would buy time and avoid surgery in the short term.

Consultation with a board certified plastic surgeon would be appropriate.  This surgeon should be able to formulate an appropriate treatment plan.

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.