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

Question

I'm a mid-40s man, aiming to get fat grafts to my hollowed tear troughs, and temples. I have good strong features. That will have a dramatic effect on my very lean face, I know, but I want to keep my naturally lean appearance.No overfill. And although I don't appear as great candidate for a neck/midface lift, when I bend over, look down, or am supine, my face really sags a lot. It bothers me a lot, too. I want to correct this without a windswept look, or scars that go into my hair. Can it be done?

Kenneth Hughes, MD · Answer

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.

Donald B. Yoo, MD, FACS · Answer

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.

J. Brian Boyd, MD · Answer

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.

Toby Mayer, MD · Answer

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.

William Portuese, MD · Answer

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.

Sutton Graham II, MD · Answer

You raise a good question with your observations about gravity and position changes.  So here's how to tell if you are a good candidate for a lift; how is your neck and jawline when in neutral position (looking forward)?  If sagging is only visible when you're positioned face down or chin down, but not at all when you're neutral, then it's probably too early for a surgical lift.  What your experiment proves is that your skin and support layers are beginning to loosen and lose their elasticity.  This is what lets us move and bend, than spring back to their original position.  Elasticity and support fades slowly over many years.  Talk with board certified plastic surgeons in person and they can discuss your concerns, and offer alternatives. 

	 

	When the timing is right, your neck/facelift should certainly be able to correct sagging without a windswept look, but your hairline can be an excellent place to conceal incisions which help your surgeon achieve the results you want.  Review your surgeons' before and after photos to assess each surgeon's results.

	 

	Finally, your raise another point of discussion.  I have used both fat and hyaluronic acid injectable fillers. I recommend fat grafts for enhancing facial volume and contours (correct malar volume loss, hollowing of the temples, thinning alongside the chin, etc.), but less frequently for the tear troughs.  The HA fillers are very good for that area, and long-lasting.

Todd C. Miller, MD · Answer

Generally speaking, a facelift/necklift will address sagging tissue in the cheeks, jawline, and neck. Keep in mind that all people will have sagging and bunching of tissue in the neck, jowls and cheeks when bending over or are in a gravity dependent position.

	I would visit with at least two qualified and experienced surgeons to determine whether or not you are a candidate for a facelift and neck lift. There are several techniques that are used to achieve a good result with a facelift and neck lift. Most of these entail incisions that go into the hairline. I would not worry so much about incisions in the hairline as these typically heal very well and are well camoflouged.

Michael R. Menachof, MD · Answer

The simple answer to your question is "probably". In general, we can accommodate most of what you seem to be looking for. More specifically, you do have a lot of qualifiers that need to be met in order for you to be happy. A personal consultation with an experienced surgeon that includes computer imaging would be a good place to really start getting some firm answers. For instance, adding volume judiciously can give you back a more youthful appearance while still maintaining a lean appearance, but will this give you what you are looking for? Imaging might help answer some of your questions. A trial with a filler would also give you a real life idea as to how the addition of volume will affect your overall lean appearance, allowing you to make sure you will like it before you do something more permanent. Good luck.

Francis R. Palmer, III, MD (retired) · Answer

It's probably in your best interest to have a consultation with a plastic & cosmetic surgeon that understands and follows the proper aesthetics of facial beauty for the creation of a naturally more handsome face.

Paul C. Zwiebel, MD (retired) · Answer

With aging, it is normal for the face to lose volume and for the facial skin to lose elasticity.
	
		Either of these or both may be contributing to the changes you are seeing, including the sagging you see when you lean forward.
	
		A facelift and/or filler/fat grafting will reduce some of the visible effects of aging, but we do not have a technique or technology that will restore lost elasticity.
	
		No surgical procedure will eliminate all the sagging when bending over or looking down.


	It is certainly possible to do a facelift without a "windswept look" or conspicuous scars, but no one can truly address your specific questions without personal examination and consultation.

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

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