Do I Need a Lower Facelift?

I'm 44 and have noticed the oral commissure starting to drop. I have considered filler in this area but I'm not sure which one is better. I've been told that I need a lower facelift to eliminate jowls and tighten my neck, yet another consult told me I just needed filler. I just had a 20% TCA peel done 2 months ago along with IPL, Fraxel and Accent. I see no improvement from any of these modalities. I'm not sure what to think at this point because I'm not sure what I need done. Thank you.

Doctor Answers 36

Timing of Facelift

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Such an good question and one that I answer every day for patients in my own practice. First of all, it is important to understand what is happening to your face as you age. Aging of face can be attributed to three ongoing age-related issues: 1. Loss of bone and supporting fat . 2. Increasing inelasticity of the skin and its attachments. 3. The effects of gravity.  Fat loss creates wasting and contour change in the upper face, while gravity contributes most to the jowl and neck areas. Loss of elasticity causes laxity of skin around the eye area and loose, wrinkled skin in the lower face and neck. 

You appear to have a bottom heavy face with prominent jowls. Your skin elasticity is still quite good and you don't have a lot of gravitational sagging in your neck.  You do have a rather significant deficit of fat in your "mid-face" region - under the eye and in your central cheek.   Injecting fat or filler in those areas will not only make your face appear less tired, but will also act to support the lower parts of your face, thereby "narrowing" the look of your heavy jowl.  Another non-surgical way to reduce the jowl is with the controlled application of heat.  We have had a good amount of success reducing the appearance of the jowl using a needle-based Radiofrequency device. Narrowing the jowl with heat while adding volume to the upper face reliably results in a more youthful appearance. This is not to say that having a face and neck lift at 40 is unreasonable, as it is not. It can be a rewarding and long lasting procedure. Since you don't have a lot of sagging of skin and muscle in the lower face, you can still choose between surgical and non-surgical options. 

NEEEDING a Facelift

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When you have a burst appendix, you NEED an appendectomy. When you have breast cancer you NEED a mastectomy. But - no one really NEEDS any cosmetic surgery. Cosmetic surgery should only be undertaken after careful consideration of all your options, from doing nothing to the simplest procedure on to the most complicated / risky procedure understanding that, just like dealing with stocks, the higher the potential gains / benefits the higher the potential risks.

Yes. You do appear to have minimal aging of the lower face. How much do they bother YOU (not your husband / boyfriend or consulting surgeon)? Would you be happy with a less than perfect but less risky procedure than a Face/Neck Lift?

The down turned "puppet lines" and lateral corners of the mouth can be significantly improved with a combination of Botox and fillers. You may wish to see a Plastic surgeon who is familiar with Sciton's ProFractional XC laser treatment (using a totally customized Erbium not CO2 based fractionated treatment unmatched by Fraxel). The last resort would be a Face/Neck Lift and various methods could be used.

I hope this helps.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Facelift at age 44

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 most patients do not require a facelift at age 44.   The primary goal of the facelift procedure this to tighten facial and neck muscles, tighten the SMAS and jowls, tighten the face and neck skin, and remove fat in the neck. The goal of facelift is not to raise the oral commissure, since he will look pulled, tightened, wind-tunneled and unnatural. For many examples of natural appearing facelifts, please see the link below to our facelift photo gallery

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Lower Facelift versus other treatments

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To some extent the answer depends on your goals. From what we can see on your single frontal photo, you appear to have some early jowling and laxity in your neck area. Along with your jowl, you are developing a perioral skin fold that extends from the commisure making your mouth look downturned. Your left side looks worse than the right, which is common.

It you want to correct the jowl and neck laxity then a facelift is really the only thing that can provide a good correction of both of these areas. On the other hand, some filler judiciously placed in the skinfold that extends from the commisure can provide a nice enhancement as long as it's not overdone. By filling the fold you will somewhat mask the appearance of the jowl and you can put off having a facelift for now.

TCA peel, IPL, and Fraxel are all skin surface treatments and you should not anticipate any significant improvement in the jowl/perioral area, as it results primarily from descent of facial soft tissues. Hopefully you were not encouraged to pursue any of these treatments with the goal of fixing the jowl and skin fold. On the other hand, your skin quality looks quite good, and this is the benefit of the treatments you have outlined.


Start Facial Rejuvenation With Small Steps

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You might consider starting with a hyaluronin filler, like Juvederm Ultra Plus, for the creases around the mouth and fine lines of the lip. Restoring volume or judicious plumping can produce remarkably gratifying results.  The fillers generally last about one year.

After trying the filler, if you are looking for more or different results, a Facelift (technique to be determined: mini, lower third, etc.) might be your next step.

Face lift and fillers

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If you analyze your face the oral commisure is good, BUT the perioral fold is hooding over making you look as if you have a down droop to the commisure.

You are starting with jowles and some neck laxity. Depending on how much this bothers you , the only option is a face lift.

Fraxel will not do any thing. Fillers will not raise the fold around the mouth on the left side. your right side is not as droopy

Samir Shureih, MD
Baltimore Plastic Surgeon

Lower facelift verses fillers for early signs of aging.

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It depends on what you want to achieve. Radiesse will fill in the nasolabial creases and marionette lines. I have many patients that are quite happy with the results from this and they last 12- 18 months. It will not correct sagging skin: you need a facelift for that.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Need for a facelift

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You do have downward descent of the cheeks, jowl formation and neck laxity. All of these will benefit from a lower facelift. Fillers and skin lasers won't do nearly as much for you. Make sure to go to the best plastic surgeon in your area and check their photos extensively to see if the look they produce appeals to you.

Time for a facelift?

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There are certainly signs of aging that a facelift and a number of ancillary procedures can help greatly.

The question, which only you can answer, is whether it is time for surgery or not.

We approach the marionette and corner of the mouth very differently than for a facelift alone, with grafting, DAO muscle division, etc. in addition to the facelift.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Do I Need a Lower Facelift?

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The best time to treat these types of concerns is early on when you start to notice a change in your skin’s laxity and/or volume. Determining which approach is best at this point is dependent upon the degree of change you are looking to achieve. Fillers such as volume can be very effective to give subtle lift to the lower face and increase volume in the cheek area. If you are looking to achieve a more aggressive lift and change, a lower facelift is a great option and would tighten the neck and give a more permanent solution to any jowling.This would be an excellent option for you. 

Richard A. Zoumalan, MD
Beverly Hills Facial Plastic Surgeon
4.9 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.