40 - looking for a frozen, plump face. Facelift or botox and filler? (Photos)

Thanks for sharing your photos and concerns. Based on what you’ve shown, you could consider either a surgical or non-surgical approach—it really depends on your goals and budget. You’re showing some early laxity in the lower face and neck, along with volume loss in the midface and under-eye area. Your forehead would respond well to neurotoxin, though aiming for a natural, refreshed look typically gives the best long-term result.

For skin quality, a CO₂ laser resurfacing treatment could help improve pigmentation, texture, and overall radiance.

In no particular order, options you may benefit from include:
• A face and neck lift
• Fat transfer or filler to the midface and under-eye region
• Neurotoxins for the upper third of the face
• A skin resurfacing procedure

Because you’re considering both structural and surface-level improvements, I’d recommend consulting with a surgeon who performs both surgical and non-surgical facial procedures. They can help you prioritize treatments and develop a plan that aligns with your aesthetic goals.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

I have been injecting Botox for cosmetic reasons since 1991. In the early days, we thought that "freezing" the muscles of facial expression was the way to go. Later we learned, that a frozen, "Kabuki dancer"-like face that was unable to move was way too artificial looking. And, so we changed to injecting Botox to calm down the dynamic muscles of facial expression so that a person could still smile, raise eyebrows, etc. when they wanted to, but looked much smoother at rest. However, if someone really wanted to look "frozen," we can merely increase the concentration and amount of Botox to achieve this.
From the photos provided, there appears to be a considerable amount of volume deficit n the cheeks. Since mid-cheek volume provides the major support for the under-eyes and is also responsible for lift from the cheeks (without which smile lines deepen), replenishing this volume with the use of an appropriately robust HA lifting filler can in one fell swoop recontour a more feminine Ogee Curve, diminish tear trough formation under the eyes, and soften the smile lines to the sides of the nose.
In experienced hands, all of the above can be performed in one treatment sessions of about 30 minutes and typically engenders little to no significant post-treatment downtime.
You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist injector expert. Best of luck.

If you've been doing little procedures to keep yourself rejuvenated and still feel dissatisfied, consider fillers to the temples and NOT the cheeks. The lateral will only make you look deflated and sunken in your temples and appear older. Also, consider tightening the skin with Morpheus and or IPL.

At age 40, it’s common to notice changes in facial volume, skin elasticity, and contour. Many people in your age group are excellent candidates for non-surgical treatments, but the best approach depends on your goals and anatomy.

1. “Frozen” Look:
If you want minimal facial movement (the “frozen” look), onabotulinumtoxinA (Botox) is the mainstay. Botox works by relaxing the muscles that cause dynamic wrinkles, especially in the forehead, glabella (between the brows), and crow’s feet. For a more “frozen” effect, your injector can use higher doses or treat more areas, but it’s important to balance this with a natural appearance and avoid heaviness or drooping.

2. Plumpness:
Loss of facial volume is a hallmark of aging. Hyaluronic acid fillers (like Juvederm, Restylane, or similar) can restore plumpness to the cheeks, lips, nasolabial folds, and under-eye area. For a more sculpted jawline, fillers can also be used to contour and soften a square appearance.

3. Jawline Concerns:
A squarer jawline can result from volume loss in the midface, increased masseter muscle activity, or changes in skin laxity.

Fillers can help restore midface volume and soften the jawline.
Botox can be injected into the masseter muscles to slim the lower face if muscle hypertrophy is contributing.
Skin tightening treatments (like radiofrequency or ultrasound-based devices) can also help with mild laxity.
4. Facelift:
At 40, most patients do not require a surgical facelift unless there is significant skin laxity or sagging that cannot be addressed with non-surgical options. Facelifts are more invasive, require downtime, and are typically reserved for more advanced aging changes.

What to Ask For at Your Next Appointment:

Express your desire for a “frozen” look with Botox, but discuss the risks of over-treatment (such as heaviness or unnatural appearance).
Ask about filler options for restoring volume in the cheeks, lips, and jawline.
Inquire about masseter Botox if you want a slimmer jawline.
Discuss non-surgical skin tightening options if you have mild sagging.
Bring photos of your younger self or examples of your aesthetic goals to help guide your provider.
Summary:
For most 40-year-olds, a combination of Botox and fillers can achieve a refreshed, plumper, and even “frozen” look without surgery. A facelift is rarely needed at this stage unless there is significant sagging. The best results come from a personalized plan created with an experienced injector who understands your goals.

If you’re interested in long-term strategies, consider asking about preventative treatments and lifestyle modifications that can help maintain your results and slow further aging, such as medical-grade skincare, sun protection, and collagen-stimulating procedures.

Hi there! First, I want to say that it’s completely normal to feel a little unsure about your next steps. Every face changes over time and it is inevitable that we all age, so what you're experiencing is normal. Aesthetic treatments should adapt and adjust to the aging process as well and a highly trained provider should be able to guide, educate and give you a full consultation on recommendations to help you feel and look your absolute best. At 40, subtle volume loss, changes in jawline shape, and fine lines become more noticeable, which is why your face may feel different even if you’ve had Botox and filler before.
If your goal is a “frozen” smooth look combined with plumpness:
Botox can help relax the muscles that create lines, especially around the forehead, glabella, and crow’s feet. A skilled injector can achieve a natural smoothness without overfreezing your face.
Dermal fillers can restore lost volume in the cheeks, under the eyes, and lips, giving that youthful plumpness and lifting the midface to support the jawline.
Jawline changes can sometimes be addressed with carefully placed filler to soften a square appearance or restore contour.
A PDO non-surgical facelift is considered if there’s skin laxity and volume loss and your provider assesses your skin to make sure that you are a great candidate. Thread lifts should be done by a highly trained and advanced provider and you have the potential to get really beautiful, natural and instant lifting effects. Many patients at 40 get excellent results with a combination of targeted Botox and filler, sometimes enhanced with skin treatments for texture and glow.
As we age we also begin to have decreased collagen production which leads to skin laxity as well as sagging skin and volume loss. In this case, bio stimulating treatments like Sculptra and Radiesse can be really beneficial and offer skin tightening, collagen producing as well as volume improve improvements.
The best approach is to clearly stay your goals to your provider, make sure they offer a full consultation and listen to your goals as well as evaluate your anatomy appropriately and then collaborate with your injector to customize a plan that balances lifting, volume rejuvenation and skin improvement.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

Based on the three post photos, I recommend a combination of mini face neck lift with muscle tightening with fat grafting to areas of the face. Fee $12,000-$18,000. Best of virtual consultant with.