Sagging cheeks and lower face. Do I need a face lift? (photo)

Thank you for your question. Based on what you’ve described—volume descent in the midface and heaviness in the lower third, but without signs of sagging in the upper face—a full facelift may not be necessary.
In cases like yours, where the goal is a more heart-shaped facial contour and the changes are mostly limited to the cheeks and lower face, the least invasive and most targeted surgical option is often an endoscopic midface lift.
This technique repositions the mid-cheek fat pads vertically, improves the nasolabial region, and helps restore facial balance—without the need for traditional facelift incisions. Compared to a “ponytail lift,” which primarily affects the upper face and temples, a midface lift directly addresses the area that’s most responsible for the concern you’ve described.
A full facial evaluation would help confirm whether this is the best approach for your anatomy and goals.
Warm regards,Op. Dr. Güray YeşiladalıBoard-Certified Plastic Surgeon

Hello,
There are numerous surgical and non-surgical options available, and determining the most appropriate approach depends on individual factors such as facial volume, skeletal structure, and chin anatomy. For patients with minimal skin laxity, I often prefer a minimally invasive technique utilizing endoscopic access with well-concealed incisions within the hairline. This approach allows for effective rejuvenation with limited scarring and a shorter recovery period.

Based off your photos - you have some midface decent (as we all do when we age) - this can potentially be re-lifted with a midface lift (can be done minimally or endoscopic through temporal incisions. Some fat grafting to the malar region (cheek area) can really help rejuvenate this area. (A traditional facelift is likely unnecessary at this point.)