My Face Sags Considerably when I Bend Over, Look Down, or I'm Supine: Will a Neck/facelift Help?

  It is possible that in addition to facial fat grafting, you may be a good candidate for face and neck lift as well.  In general, if you have loose skin, hanging muscle, or any fat, a neck lift may be in order.  Also, the jowls can be addressed with a face and neck lift as well.  You can easily avoid the windswept look with the right surgeon.

Mid-40s is young, but not too young to be considering a facelift to improve the sagging of your facial skin and tissue.  How is your cervicomental angle (the angle your neck makes with your jaw) in a normal, upright position?  Do you have jowling along your jawline?  All of those areas can be improved without giving you a windswept look.  With carefully designed and meticulously executed incisions, the scars can be hidden for the most part and nearly imperceptible.  

Sounds like you would benefit from a facelift, but the precise combination of techniques would be determined by a consultation with a Board Certified Plastic Surgeon. Be careful with fat grafting to the tear troughs. I have seen some bad results that are impossible to correct; and there are alternatives.

Face or neck lift for early sagging is what you need. It should look totally natural with the scar NOT out in front of the ear and not pulled. Do NOT get fat injected into the tear troughs as this will often make a sausage under your eye even when the surgeon says it won't--unless it is a fat transfer done with a lower blepharoplasty.

A facelift is performed when there is excess skin on the face, which includes jowling and excess neck skin.  The facelift involves fat removal from the neck, tightening the platysma through a platysmaplasty procedure, and tightening excess skin, which lifts the jowls.  It is important to make the assessment of saggy skin while in an upright sitting position and not in a leaning over position.