Almost 48 - how to improve lower half of face and hooded eyes? Is upper bleph & lower facelift only way to go? (Photo)

I've always had hooded eyes but it seems the last few years the outer edges pull down more, making me look tired. Also my jawline and lower half of my face pulls downward. I had neck lipo 10 yrs ago and now my neck just looks older than I think it should with some looseness. Would a lower face lift/neck lift be the way to go or just add more volume in my cheeks? I also do not like the indentations on either side of my chin. Would adding filler there be a good solution that is less invasive?

Doctor Answers 7

Typically, surgery is the best option for more advanced facial aging

Hello,
   M I realize that today there are many more options for non-surgical facial rejuvenation than ever before. There seems to be newer and more advanced tools coming onto the market each year that claim to lift and tighten loose facial and neck skin and remove years of an aged appearance without undergoing the knife. While most of these costly gadgets and gizmos are relatively safe, I do not believe that non-surgical radiofrequency facial skin tightening or lifting treatments work well. If you have moderate or more severe skin laxity of your jowls, neck, brow, or eyelids and you expect Thermage or Titan or Ultherapy to dramatically improve your appearance, you may very well be disappointed with the results. This is a valid statement if you have high expectations for the radio frequency device.
     A different non-surgical rejuvenation treatment are Fillers (either commercially prepared or autologous fat) and many times are excellent options to camouflage the signs of aging if you demonstrate early or mild to moderate signs of facial aging or you are not ready for a more invasive treatment option such as a lower face and neck lift. It is of utmost importance to pair your choice in treatments with realistic expectations. Typically, the radiofrequency devices result in mild improvements in overall skin laxity and even when the result is better than mild I believe the longevity of the result is quite short lived. In addition, the cost of these "non-invasive" procedures is relatively high. I believe that time tested and reliable surgery is a better option when it comes to achieving noticeable and lasting facial rejuvenation. When the neck demonstrates significant laxity and hangs, there is not a good alternative to surgery (including the use of fillers). On occasion, trying a non-surgical option is reasonable and may satisfy the properly chosen patient.
     One exciting non-surgical option mentioned above for facial rejuvenation are the volumizers or what we call dermal fillers. Fillers have become an excellent option in well chosen patients to camouflage the signs of the aging face. If a person desires facial rejuvenation but is not ready for surgery, it is remarkable when using the proper volume and placement, how a filler can satisfy a patients expectations and surgery can be delayed until a future time. For example, fillers placed in the cheeks or mid face will fill in the lost volume associated with the aging face and also lift the face to a degree, helping to minimize nasolabial folds and hide the ptotic (droopy) cheek. In addition, well placed filler along the jaw line can create a more uniform or straight line from the ear to the chin, which is associated with a youthful appearance of the lower face as opposed to a "wavy" appearance of the jaw line which is indicative of jowl formation and an aged appearance. Overall, if someone is completely against surgery, has early signs of aging or is not a surgical candidate because of health problems then alternative remedies such as dermal fillers or radio frequency devices are a reasonable alternative to surgery.
     In your case, your eyebrow is in an excellent position. You should do very well with an upper eyelid blepharoplasty and there is no other good alternative. This procedure is safe and effective. Your "jowling" is mild or moderate and you may be satisfied with fillers to camouflage this area, including the indentation you are speaking of along your jaw line. The amount of laxity on your neck will respond to surgery better than any other treatment. You already had liposuction of this area years ago and now it appears you only have loose skin. Lastly, as with any profession, choosing your health care provider based on experience and consistently good results is critical. I hope I helped answer your questions

Typically, surgery is the best option for more advanced facial aging

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello,
   M I realize that today there are many more options for non-surgical facial rejuvenation than ever before. There seems to be newer and more advanced tools coming onto the market each year that claim to lift and tighten loose facial and neck skin and remove years of an aged appearance without undergoing the knife. While most of these costly gadgets and gizmos are relatively safe, I do not believe that non-surgical radiofrequency facial skin tightening or lifting treatments work well. If you have moderate or more severe skin laxity of your jowls, neck, brow, or eyelids and you expect Thermage or Titan or Ultherapy to dramatically improve your appearance, you may very well be disappointed with the results. This is a valid statement if you have high expectations for the radio frequency device.
     A different non-surgical rejuvenation treatment are Fillers (either commercially prepared or autologous fat) and many times are excellent options to camouflage the signs of aging if you demonstrate early or mild to moderate signs of facial aging or you are not ready for a more invasive treatment option such as a lower face and neck lift. It is of utmost importance to pair your choice in treatments with realistic expectations. Typically, the radiofrequency devices result in mild improvements in overall skin laxity and even when the result is better than mild I believe the longevity of the result is quite short lived. In addition, the cost of these "non-invasive" procedures is relatively high. I believe that time tested and reliable surgery is a better option when it comes to achieving noticeable and lasting facial rejuvenation. When the neck demonstrates significant laxity and hangs, there is not a good alternative to surgery (including the use of fillers). On occasion, trying a non-surgical option is reasonable and may satisfy the properly chosen patient.
     One exciting non-surgical option mentioned above for facial rejuvenation are the volumizers or what we call dermal fillers. Fillers have become an excellent option in well chosen patients to camouflage the signs of the aging face. If a person desires facial rejuvenation but is not ready for surgery, it is remarkable when using the proper volume and placement, how a filler can satisfy a patients expectations and surgery can be delayed until a future time. For example, fillers placed in the cheeks or mid face will fill in the lost volume associated with the aging face and also lift the face to a degree, helping to minimize nasolabial folds and hide the ptotic (droopy) cheek. In addition, well placed filler along the jaw line can create a more uniform or straight line from the ear to the chin, which is associated with a youthful appearance of the lower face as opposed to a "wavy" appearance of the jaw line which is indicative of jowl formation and an aged appearance. Overall, if someone is completely against surgery, has early signs of aging or is not a surgical candidate because of health problems then alternative remedies such as dermal fillers or radio frequency devices are a reasonable alternative to surgery.
     In your case, your eyebrow is in an excellent position. You should do very well with an upper eyelid blepharoplasty and there is no other good alternative. This procedure is safe and effective. Your "jowling" is mild or moderate and you may be satisfied with fillers to camouflage this area, including the indentation you are speaking of along your jaw line. The amount of laxity on your neck will respond to surgery better than any other treatment. You already had liposuction of this area years ago and now it appears you only have loose skin. Lastly, as with any profession, choosing your health care provider based on experience and consistently good results is critical. I hope I helped answer your questions

Almost 48 - how to improve lower half of face and hooded eyes?

Thank you for your question and photographs Ms. Minter. You have droopiness of your neck and prominence of the platysma muscle bands that would best be treated by a necklift combined with a facelift procedure. The facelift also gives you the opportunity to lift your jowls, fill in the prejowl indentations adjacent to your chin and have fat grafting to your cheek area to both rejuvenate your skin and enhance volume and proportioning. Your upper eyelids would also benefit significantly in my opinion from blepharoplasty. Please realize that these recommendations are based only on a review of photographs and that you need to be seen in a face-to-face setting with a ABPS board-certified plastic surgeon for best advice.
Performing a face and necklift surgery in a manner to give natural long lasting result with camouflaged incisions is extremely important in my opinion. Please review the video above for more information that may be helpful to you. Best wishes and good luck.


Jon A Perlman M.D., FACS
Certified, American Board of Plastic Surgery
ABC-TV Extreme Makeover Plastic Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Almost 48 - how to improve lower half of face and hooded eyes?

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Thank you for your question and photographs Ms. Minter. You have droopiness of your neck and prominence of the platysma muscle bands that would best be treated by a necklift combined with a facelift procedure. The facelift also gives you the opportunity to lift your jowls, fill in the prejowl indentations adjacent to your chin and have fat grafting to your cheek area to both rejuvenate your skin and enhance volume and proportioning. Your upper eyelids would also benefit significantly in my opinion from blepharoplasty. Please realize that these recommendations are based only on a review of photographs and that you need to be seen in a face-to-face setting with a ABPS board-certified plastic surgeon for best advice.
Performing a face and necklift surgery in a manner to give natural long lasting result with camouflaged incisions is extremely important in my opinion. Please review the video above for more information that may be helpful to you. Best wishes and good luck.


Jon A Perlman M.D., FACS
Certified, American Board of Plastic Surgery
ABC-TV Extreme Makeover Plastic Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

What todo for eyes and face

As far as your neck and  lower face, I would recommend a repeat lower face and neck lift and consider a pre-jowl implant (it will re-establish the neck-jaw contour and minimize the indentation lateral to your chin). At ten years, you are at the upper average range for a face lift to last- perfect time for a touch-up. Your upper eyes would definitely be improved in appearance with an upper blepharoplasty to remove excess fat and skin. Seek out a facial plastic or plastic surgeon with experience and expertise in these areas.

Robert J. Smyth, MD
Cincinnati Facial Plastic Surgeon
3.5 out of 5 stars 11 reviews

What todo for eyes and face

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As far as your neck and  lower face, I would recommend a repeat lower face and neck lift and consider a pre-jowl implant (it will re-establish the neck-jaw contour and minimize the indentation lateral to your chin). At ten years, you are at the upper average range for a face lift to last- perfect time for a touch-up. Your upper eyes would definitely be improved in appearance with an upper blepharoplasty to remove excess fat and skin. Seek out a facial plastic or plastic surgeon with experience and expertise in these areas.

Robert J. Smyth, MD
Cincinnati Facial Plastic Surgeon

Mini facelift and eyelids

This most significant different you can make is to have a modified extended deep plane facelift which addresses the neck and cheeks together. There is no other type of lift that can do this so naturally.  You have to look at many before and afters to see why this is best.  The eyes need to be examined in person as you have a slightly atypical fullness in the left more than the right.  Still your best option for that might be upper eyelid surgery with removal of the nasal fat pad only. It's hard to see if there is any lacrimal gland prolapse or filler contributing to the fullness. 

Ben Talei, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 50 reviews

Mini facelift and eyelids

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
This most significant different you can make is to have a modified extended deep plane facelift which addresses the neck and cheeks together. There is no other type of lift that can do this so naturally.  You have to look at many before and afters to see why this is best.  The eyes need to be examined in person as you have a slightly atypical fullness in the left more than the right.  Still your best option for that might be upper eyelid surgery with removal of the nasal fat pad only. It's hard to see if there is any lacrimal gland prolapse or filler contributing to the fullness. 

Ben Talei, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 50 reviews

Almost 48

Thank you for your question. I think that for your lower face and jowls a mini lift would be a good option. For your hooded upper eyelids, I would recommend a blepharoplasty. You should get a consultation with a board certified facial plastic surgeon. Good luck 

Almost 48

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Thank you for your question. I think that for your lower face and jowls a mini lift would be a good option. For your hooded upper eyelids, I would recommend a blepharoplasty. You should get a consultation with a board certified facial plastic surgeon. Good luck 

Is upper bleph & lower facelift only way to go?

The areas you have mentioned that concern you - in my opinion- are best treated surgically. The fullness of the upper lids can best be managed with an upper lid Blepharoplasty and possibly a coronal brow lift. The neck is the most profound tell tale sign of the aging face, and can best be treated with a surgical neck lift. These combinations of procedures when performed early in life- give the most long lasting and fulfilling result

Is upper bleph & lower facelift only way to go?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The areas you have mentioned that concern you - in my opinion- are best treated surgically. The fullness of the upper lids can best be managed with an upper lid Blepharoplasty and possibly a coronal brow lift. The neck is the most profound tell tale sign of the aging face, and can best be treated with a surgical neck lift. These combinations of procedures when performed early in life- give the most long lasting and fulfilling result

Almost 48 - how to improve lower half of face and hooded eyes? Is upper bleph & lower facelift only way to go?

Thank you for your questions and series of photographs.  I do feel that you would be a good surgical candidate to address your two areas of concern - upper eyelids and jawline/neck.  An upper lid blepharoplasty will improve the hooding and excess skin present leaving you with an improved eyelid contour and appearance.  I do not think that fillers placed into your cheeks will have enough of an effect on your jowling and neckline and a lower face lift/neck lift would better help achieve the improved jawline you are after.  See an ASPS board certified plastic surgeon in consultation. 

Almost 48 - how to improve lower half of face and hooded eyes? Is upper bleph & lower facelift only way to go?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your questions and series of photographs.  I do feel that you would be a good surgical candidate to address your two areas of concern - upper eyelids and jawline/neck.  An upper lid blepharoplasty will improve the hooding and excess skin present leaving you with an improved eyelid contour and appearance.  I do not think that fillers placed into your cheeks will have enough of an effect on your jowling and neckline and a lower face lift/neck lift would better help achieve the improved jawline you are after.  See an ASPS board certified plastic surgeon in consultation. 

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.