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 32

Facelift at age 44

 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

Seattle Facial Plastic Surgeon
4.5 out of 5 stars 107 reviews

Lower Facelift versus other treatments

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

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.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.5 out of 5 stars 27 reviews

Face lift and fillers

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
5.0 out of 5 stars 6 reviews

NEEEDING a Facelift

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
5.0 out of 5 stars 93 reviews

Lower facelift verses fillers for early signs of aging.

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
5.0 out of 5 stars 30 reviews

Time for a facelift?

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
5.0 out of 5 stars 126 reviews

Need for a facelift

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.

Lower Facelift

Unless you are mentally prepared for surgery, you are not ready. You may be better with dermal fillers (most likely juvederm) to start. Consult in person with an experienced and expert board certified plastic surgeon.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 32 reviews

Los Angeles lower facelift and Ulthera options in Santa Monica

Your skin quality appears good. I would consider an Ulthera procedure to tighten the lower face and jawline areas if that is an area of concern.

Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 85 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.