Mid 40s & visible NL folds & marionette lines - do I need a facelift or just fat transfer or fillers? (Photos)

Hello,
You are not a good candidate for a facelift and any suggestion to the contrary is not a thoughtful analysis of what is in your best interest. The nasolabial fold is the least long term corrected area following a facelift. Soft tissue fillers can be a good experiment for you to see what volume enhancement would do for any particular area of your face. You can then go to the next step of facial fat grafting which may be a more permanent solution.
Maybe best to consider a second visit with those surgeons that did not suggest a facelift and discuss fillers first. Good luck.

I would recommend a deep plane mini facelift. This would support your jowls and midface and also tighten your neck with scars hidden in the contour of your ear. I agree the filler and fat will just puff the face without noticeable improvement in these areas.

Hi,Based on your photos I think you are on the cusp between a facelift and less invasive procedures. I would never add a significant amount of fat to the lower part of the face. It can lead to heaviness and worsening jowls as you age. I think you would be a great candidate for a mini lift but I agree you don't really need it. It can help improve your jawline significantly but with some tailored fillers and possibly some skin tightening procedures like radiofrequency you should be able to hold off for another few years. Both options are reasonable. Hope that helps. Best,Matthew Tamplen MD

Given your concerns about the visible nasolabial folds and marionette lines, as well as the sagging skin in the lower face, the most suitable approach would be a combination of a mini facelift and, if necessary, fat injection. A mini facelift is a less invasive facelift technique performed with smaller incisions. It specifically addresses the sagging skin in the lower face and offers a quicker recovery time and less extensive intervention compared to traditional facelifts.
With a mini facelift, we can reduce the appearance of nasolabial folds and marionette lines. Additionally, excess skin in the lower face can be tightened, resulting in a more youthful and firmer profile. If there is volume loss in the lower face, fat injection may also be considered. Fat injection provides natural and youthful volume, and its necessity will depend on the structure of your face and the extent of volume loss.
The combination of these procedures will lead to a natural tightening and rejuvenation of the lower face. However, to determine the most appropriate course of action, I recommend starting with a physical examination. This will enable me to design the most effective treatment plan based on the specific characteristics of your face.

Dear Fierce,From the photos you are aging well and very gracefully! Many would say you don’t need to do anything and I would agree but I do see many patients in more recent years who want to do preventative surgery earlier in life. And what I have noticed is that the results tend to heal better and last longer the earlier the intervention is done (younger skin and soft tissue usually will heal better than older soft tissue). So this makes sense to me. Fat grafting or filler can make the area more subtle, the more modern approach is to combine that with a mini facelift.

Thank you for your query. Fillers can certainly help with marionette lines and NFL. A mid facelift can also improve the slight sagginess of the cheek area as well as with NFL and marionette lines. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

It does not look that you would have any benefit of face/neck lift. The best option to treat M lines and NLF is filler. Good luck.

It appears from your photographs that you have had a previous lip lift. Sometimes the lip lift will take out tissue centrally and not the corners. What happens then is that the corners are turning downwards. You may consider repeating the lip lift with wider excision laterally to pull up the corners. At the same time, fat transfers to the nasolabial folds or marionette deformities may be helpful but may not be needed.

Best Wishes,

Gary Horndeski, M.D.

Hello, hope you are well. Thank you for posting your questions and photos! "Is adding fat to the lower face a bad idea because there will be more volume to sag in the future?" Bingo. Adding volume to the lower face with filler and/or fat transfer is contradictory to a slim, youthful jawline. Things can look good for a while, but repeatedly following that path is a recipe for lower facial heaviness and exacerbating the aging process. Facelift surgery remains the gold standard method of restoring a youthful facial contour.

Best,
Dr. Tower

Hello,
It’s extremely common that patients face the pivotal choice between non-surgical enhancements like fillers and fat transfer, or a more lasting solution through a facelift. While fillers and fat transfer are appealing for their accessibility and immediate effects, they may not deliver the transformation that you may be seeking.
Fillers and fat transfer primarily work by adding volume to areas that have lost fullness over time, such as the cheeks, under-eyes. However, adding volume alone doesn’t address sagging skin or weakened support structures. In fact, because the ligaments supporting your facial tissues have started to lose strength, adding more weight—whether through fillers or fat—can actually make the face appear heavier, pulling it down further instead of lifting it up.
While fillers provide a temporary plumping effect, over-relying on them may even distort facial contours over time, leading to a “puffed” look rather than a natural, lifted appearance. For patients who will eventually opt for surgery, excessive filler use can also interfere with the integrity of facial tissues, making future lifts more challenging.
Unlike fillers and fat transfer, a facelift doesn’t just add volume—it repositions and tightens the skin and underlying structures for a more youthful, lifted look. A skilled surgeon will adjust muscles, remove excess skin, and enhance contours in a way that restores natural facial proportions. This approach is particularly effective when the skin still has elasticity but may be beginning to show signs of sagging.
With a facelift, you achieve structural support, not just volume. It addresses sagging at the root by lifting the deeper layers, restoring a natural and long-lasting rejuvenation that fillers and fat transfer can’t replicate.
If your primary goal is to look refreshed and lifted rather than just fuller, a facelift may be your best option. Fat transfers are often valuable as a finishing touch after a facelift, but on their own, they lack the lifting power necessary to fully restore a youthful appearance.