40 yrs old male, droopy neck line, deep nasolabial folds, saggy lower face. Surgical facelift vs. Liquid facelift? (photos)

Dear @Seduard2021, thank you for your question and showing your pictures. Based on the photos, and considering natural results to the long term, I recommend a facelift for the second and third thirds of your face. This includes the first third of the neck. This would be part of surgical plan for you to obtain better results as the expression of the eyes is not be visible. During this type of procedure, it is important to develop a surgical plan that considers the relationship between the areas to be treated and the other areas of the face to achieve a balanced, harmonious and long-lasting result. Best wishes! Alan Gonzalez MD, FACS.

From your photos you would be best served by a surgical face/necklift. It does not appear as though you have a lack of volume or hollow areas that dermal fillers can correct. Rather, you have a healthy, full face, but with laxity of the skin and deep tissues. Adding volume in the form of fillers will only serve to make you appear puffy. You require lifting and tightening.

Dear Seduard2021,

Thankyou for providing pictures for reference. As it seems that your are experiencing face laxity where the tighteness and firmness of the skin is lost. In this case if you would like to have a more permanent and longer lasting affects I would recommend to get a full-face lift, where the neck, mid-face, and upper temporal part is targetted. Make sure to search for an expert surgeon who can target all problematic areas using a scarless and endoscopic method as well as a vertical not horizontal facelift to make sure the saggy and droopyness can be fixed without giving an artificial and pulled appearance . Futhermore, you can additonally benefit from fat injections into your deep nasolabial folds to fill in the lack of volume.

Best Regards,
TAS TEAM

Thank you for submitting your question and photos. A surgical facelift is ideal for angulating a droopy neckline and lower face while addressing deep nasolabial folds. When performed by an experienced facial plastic surgeon, a facelift can provide favorable, natural-looking results.
After identifying the deep fascia tissue and muscle, it is lifted upward in the cheek and outward in the neck area. The tissue is then secured with sutures and any excess skin is removed. Closing the incisions with deep sutures and no tension can allow the incisions to heal to the point of being nearly invisible. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns, suggest the best approach, and answer any questions you may have.

Men tend to have thicker skin than women, and, for that reason, Ulthera tends to deliver less satisfactory results for men. Juvederm might make your nasolabial fold less deep, but, overall, it will add more volume to your face, without lifting the soft tissues, which is what you really want to achieve. Unfortunately, a facelift can not be performed without making incisions, which become scars.
However, you might be a candidate for a short scar facelift, which we perform in our practice with an endoscope, allowing us to hide part of the scar inside the ear, and to end the length of the scar at the earlobe. This might be a preferred option for you in light of your short hair.

A mini facelift is a great option for many people. The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day and there are no scars behind the ears and you can wear your hair up anytime and most patients take no pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature. I'd recommend not getting into the mindset of thinking the jowls or neck skin will be 100% gone with a mini facelift or neck lift as this might lead to disappointment. It is always best to consider that an area will be improved and discuss how much with your plastic surgeon.

Surgery is not for everyone. In today's day and age, there are many nonsurgical options to consider although surgery usually gets the most improvement specifically of the neck and jowls.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of mini facelifts and neck lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Have a great day!

Based on your photos, I notice most the deep nasolabial folds with upper and lower jowl bulges behind them and a depression between the upper jowl bulge and your cheekbone prominence. This could be improved with a vertical oriented short scar facelift that leaves a scar running along the front border of the ear and then up into the temporal scalp or along the border of your sideburn. However, the scars of a standard facelift would be very obvious behind your ears and in the back of your neck due to your short hair style. Even the scars from a short scar technique might be a problem, which you would need to consider. Fillers or fat grafting into the cheeks should fill in the central cheek depression and possibly lift the jowls by your nasolabial folds a little, but I think that the surgical lift would create more improvement. There is one other option for men, although not frequently performed. That is to directly remove the deep groove running from your nose down below your mouth and the bulge behind ( the nasolabial fold and the jowl fullness).. This smooths that area and leaves a scar that falls within the pre-existing crease so it looks like a normal landmark.

Based on your photographs, you have some great options. First off, I agree that a bunch of HA filler like Juvederm would not be optimal for you, and ultherapy is often very underwhelming. You are a candidate for a surgical facelift with fat grafting to the cheeks and nasolabial folds, but at 40 your improvement from a surgical facelift will be a bit less dramatic than it is in older patients.
To avoid the facelift recovery and scars, another great option would be submental liposuction with radiofrequency skin tightening to the submental area and lower face. I would couple this with fat grafting to the cheeks and nasolabial folds, and possibly some Radiesse to the jawline depending on your examination. Of course, be seen in person by a plastic surgeon and examined to confirm and formulate an exact plan, but a combination of smaller procedures like this can give a great result with less recovery than a facelift, and keep you looking like yourself.

Some people look young at 60, while others at 40 can look older. Ageing is the result of many factors such as genetics, health, environmental exposure, weight, etc. In other words, there is not a set age for facelift surgery. I have found that my male facelift patients, when I meet them in consultation, are nervous about incisions, referencing the social stigma of men having surgery. However, you would be surprised how many men I operate on! Quite a number of my postoperative patients state that surgery gives them a social and business edge. This is why I work in a painstaking way to make the incisions as invisible as possible. In order to give you the best advice, however, about how to address your concerns, I would suggest that you seek in-person consultations with board certified plastic surgeons. As a surgeon, I can’t emphasize enough the value of being able to examine my patients in person to judge the elasticity of the skin, to see you in different light, etc. Surgery warrants a substantial time and effort in research.

Everyone ages at a different rate. Some patients at 40 have more aging than those much older. It depends on numerous factors including: heredity, history of smoking, lifestyle, sun exposure, excessive exercising, underlying medical health, and significant weight loss. There are numerous options to address early aging: fillers which are temporary and will not lift your jowls, micro-fat grafts which are long lasting but don't significantly elevate drooping , limited facelifts (including mid-face lifts) plus filling of the depressed areas produce the most aesthetically harmonious and longest lasting result. Each has benefits and drawbacks.

It really depends more on the extent of aging than chronological age, although 40 is certainly young for a facelift. Facelifts at a younger age have been shown to last longer in some studies and there is no limit to the number of facelifts that someone can have.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California