Facelift or something else? (Photo)

I'm 47 years old and this is what my lower face looks like. I had Ultherapy last year with no help Plastic surgeon who did Ultherapy stated it was too early for facelift for me I also had fillers to augment the cheeks in hopes to elevate the sagging of lower face without any improvement . The laxity gets worse very fast , I really want to do something about it . I would like to know what is the right procedure for me? And If Facelift , what kind? What are the expected results /recovery?

Doctor Answers 37

There are options to rejuvenate your neck and lower face from non-surgical treatments, limited lifting, and structural fillers

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Thank you for your question. You’re 47-years-old and submitted several very good photos of your neck and lower facial area. You had Ultherapy with a plastic surgeon which did not work, and your plastic surgeon said it’s too early for you to have a facelift. You had some injectable fillers placed on your cheeks in an effort to try and lift the skin, but you state it was not successful. You are looking for some guidance about your options.

I can give you my perspective and opinion on how I approach patients like yourself. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I’ve been performing facelifts from the very beginning, offering a full range of face lifting and neck lifting procedures, as well as non-surgical options. I can explain a little bit about what your options would be if someone like yourself comes to our office.

The skin under your neck reveals certain issues. You have some  platysmal banding, so suggestions will come up like using Botox® to relax the platysma.  You describe fillers to help lift, it does bring to mind an option also with fillers called structural volumizing. Regardless of the placement or the intention of adding volume in the face, there is a real distinction on technique when it comes to using fillers to cause a lifting effect.

When we do structural volumizing, we are actually placing filler such as Juvederm and Juvederm Voluma at the level of the bone structure. At a certain level of the bone structure, it actually restores volume where volume is lost and it allows redefinition and some lifting of the skin. It is not necessarily the only thing that will get you where you want to be. The simple challenge with thermal energy devices, regardless of whether it is Ultherapy, radiofrequency devices, and Nd:YAG laser which we use in our practice is there’s a limited amount of overlap where skin quality creates enough tightening that there is some degree of elevation. In general, the challenge really is the sagging of the underlying tissue which limits the effectiveness of any treatment which involves non-surgical skin tightening. In skin remodeling, which ultimately is really what’s happening, I try to help people understand there is a distinction between skin quantity and skin quality.

There are a couple of different options available for you. One option is a limited short scar face lifting procedure. With due respect to your plastic surgeon,there are definitely people who benefit from a little amount of lifting where the soft tissue including the SMAS, which is the muscle layer, and the cheek area on the face, as well as the platysma which you would contribute to those bands when lifted. A limited lifting procedure will actually relieve the tension on the skin, and that’s a very important part of this.

The other procedure we recommend is a suture suspension procedure, which is not a thread lift. This is not the barbed suture technique where skin to skin is being tightened where often there is a lot of regression, which gave thread lifts a lot of negative press. Suture suspension is a method of fixating or elevating the sagging tissue to a structure that is more stable, and restoring tissue in a way where you don’t have to open up the skin. The point is if your doctor feels you don’t have enough extra skin to justify done in a face lifting procedure without removal of skin. The reason it works is the general resiliency of skin, depending on age, will actually retract when there isn’t physical weight on the skin. That also means if there is re-suspension of the deeper tissue, then you can also get the opportunity to maybe revisit some thermal energy tightening procedure afterwards to further enhance that. Often it is not necessary and again it has to be customized.

There are options for you and it is a challenging area, so I certainly understand the frustration. Sometimes there are not enough things because unfortunately there is a disproportionate amount of aging that happens in the neck relative to the face, but in my opinion it is often the best solution to have a combination approach.  You have visited some elements of this, and hopefully what I describe in terms of Botox® for the platysmal bands and suture suspension may give you another perspective on options. I hope that was helpful, I wish you the best of luck and thank you for your question.

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Treatment Options for the Lower Face

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During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.

If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.
Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic may also be a candidate for a Lite Lift™.

It is also possible to #combine #surgeries. In fact, I commonly recommend other procedures to go accompany a facelift, such as blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result.

It's time to consider a facelift.

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The photos show that you would probably be a great candidate for a facelift. The lift will tighten the neck, remove the neck banding, elevate the jowls and remove any excess skin.  Ultherapy will never give you the same caliber of results as surgery, despite the fact that it is marketed as a surgical alternative. Fillers will replace lost volume but will not provide a significant lift. Only surgery will give you the clean neck and jawline you are seeking. 

Neck lift

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Based solely on your photo, it looks as if your issue is skin and muscle laxity in your neck and lower face. Neither of which can really be helped with non-surgical techniques. My best advise would be for you to schedule a consultation with a board certified plastic surgeon in your area to discuss a lower face/neck lift. Hope this helps.


Kouros Azar


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As I look at your pictures, the main component of your aging seems to be due to muscle looseness in the lower face and neck.  The other component is skin looseness.  Non invasive, minimally invasive, and skin tightening will fall short  when it comes to achieving the results that you want. Based on  your photos, your best treatment option will most likely  be a lower facelift and neck lift (platysmaplasty). Make sure to discuss both of these with the surgeon who is going to treat you. 

Facelift or something else?

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It appears that you would benefit from a face and neck lift. Ancillary procedures such as Ultherapy will not give nearly the results that a well performed face lift will. Fillers can be used to augment the surgical results, but they will not lift sagging tissues. Good luck.

Face lift

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Thank you for your question and for attaching photos. From your photos, it appears you are a good candidate for a face lift. This will tighten your platysma bands in your neck and give you a more youthful jaw line. Procedures such as Ulthera do not produce any long lasting results. The satisfaction rate from a face lift is extremely high and the recovery is quite quick. I would suggest seeing aboard certified plastic surgeon in your area for a full history, exam and consultation to determine if a face lift is indeed the right procedure for you. Good luck.

Laxity of the jawline and neck

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The ultimate treatment for sagging of the jawline and neck is a facelift. All the non surgical procedures such as thermitight or Ultherapy only give a fraction of the results that a facelift will achieve. 

That being said, I would suggest you visit a plastic surgeon that specializes in faces in order to assess your options. Sometimes even a chin implant can get results for minimal laxity. Other times it can be combined with some of the nonsurgical or minimally invasive options. While other times a facelift is the ideal solution. 

Jacob D. Steiger, MD
Boca Raton Facial Plastic Surgeon
5.0 out of 5 stars 68 reviews

Lower face and neck lift

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From this photo, it seem like you would get a great result with a lower face and neck lift. An in person exam would be needed to come up with the best treatment plan. Find a board certified plastic surgeon in your area with expertise in facial aesthetics. In my practice in the San Francisco Bay Area I have come to the conclusion that the happiest patients are those that have realistic expectation on what a procedure will and won’t do for them. Good luck!  Dean Vistnes. 
Vistnes Plastic Surgery #realself #drdeanvistnes #lowerfaceandnecklift

Neck Bands

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For younger patients such as yourself I have had great success with Botox injections to the platysma for improvement of the bands. This can improve the vertical lines in the neck that you may find bothersome. Good luck!

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