Would I benefit more from fillers or a facelift? 53 y/o female concerned about symmetry, hollow eyes and flat face (photos)

Question

Female age 53, uncomfortable with total lack of symmetry, flat face, hollowed out eyes. Wondering if I could benefit from fillers or facelift more likely achieve more beneficial outcome?

Zoran Potparic, MD · Answer

After good analysis of your photos it is my impression that face and neck lift, combined with eyelids surgery and possibly fat grafting of the cheeks and around the eyes, would be good set of procedure for your condition. These procedures can be done in one setting or they can be divided based on your priority. In person consultation or teleconference with a board certified plastic surgeon with expertise in these procedures, is recommmended. Hope this helps.

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Jeffrey H. Spiegel, MD · Answer

Yes, fillers can help, and yes, a facelift will be even better.
You have some flattening of the front of the cheeks, a recessed chin, jowls, and skin laxity.  Fillers to the cheeks and chin can help improve this.  A facelift with chin implant and fat grafting will do wonders, however.  At this point, you need to decide what feels right.  Fillers are a quick way to get some improvement.  The surgery is a bigger investment in time and resources but should give you many years of improved quality of life, confidence, and satisfaction.

Ronald J. Edelson, MD · Answer

You have a sufficient amount of looseness of the skin of your jowls and neck to justify a facelift. You can try fillers if you like but they won’t do much and are expensive. If you don’t think you are ready for a facelift you could hold off a few yesrsc

Ram Kalus, MD, FACS · Answer

Clearly and evaluation in person would be required to propel determine how to best help you chive your goals. However, that said, there are several things that can potentially be helpful other than or in a addition to a facelift. You do have some early heaviness of your upper eyelids which can contribute to a tired appearance, and this can be nicely corrected with an upper blepharoplasty (eyelid tuck). You also appear to have some jowl formation related to natural settling of the deeper soft tissues beneath the skin, along with some natural skin laxity that is age appropriate. You also appear to have some volume deficiency on the skeletal level in your mid face/cheek areas and this can be camouflaged nicely with fat grafting, cheek implants, or injectables , implants and fat being more permanent. This can also restore some more aesthetic proportions to give you more width in your mid face since you have a relatively long yet narrow face. You also seem to have have hyperactivity of your chin muscles which can be improved with conservative injections of Botox, and although your profile picture is suboptimal it appears that you have a slightly under projecting chin, and this can be corrected either with fat, or with a chin implant. Finally, you appear to have some acne scarring that may benefit from laser skin resurfacing.

At the risk of overwhelming you, please consult with an experienced board certified plastic surgeon who can properly evaluate you and help you on your journey of addressing your concerns and ultimately meeting your goals of a achieving a restorative youthful enhancement. Best of luck to you.

At the risk of overwhelming you, please consult with an experienced board certified plastic surgeon who can properly evaluate you and help you on your journey of addressing your concerns and ultimately meeting your goals of a achieving a restorative youthful enhancement. Best of luck to you.

William Portuese, MD · Answer

The photographs demonstrate significant facial asymmetry which can be improved, but your face will not be perfect. Consider placement of a chin implant to augment your recessive chin forward, and custom carved to build up your left side of your chin more than your right. This can be done in combination with the lower face and neck lift to lift the Jowls, tighten loose facial and neck skin, tighten loose facial and neck muscles, and remove any fat deposits in the neck

Darryl J. Blinski, MD · Answer

Based on the 2 posed photos I would offer both! A mini Face/Neck lift with SMAS plication with 4-6 syringes HA fillers. Fee $12,000+ Best to virtual consult with.....

Adam Goodwin, MBBS, FRCS(Plast) · Answer

thanks for your question and photos.

There are two issues at play here.

You have a fundamental asymmetry affecting your bottom 2/3 of your face. Your nose, mouth, jawline and therefore cheek all differ from one side to the other. No surgery, other than extensive, corrective surgery is likely to change this significantly, but, this is the face shape you have always had and so you may not choose to change that.

In terms of your facial ageing, then I think you are beyond filler as a comprehensive solution.

You have a flat face as you say, jowls, loss of jawline definition and an early sagging neck.

Some form of facelift procedure is almost certainly the best option for you at this time. You may choose to add a little bit of volume as you're very slim.

Hope that helps.

I have discussions of many of these problems on my YouTube channel, Adam goodwin surgery, if you might be interested.

Best wishes, Adam, Goodwin.

Jose Segura, MD, PhD - Account Suspended · Answer

Hello Lyann, Thank you for sharing your photographs and the asymmetry is more marked on the left side, according to what is observed, it probably requires a mandibular angle and chin prosthesis; in addition to fat grafting or filler material to give symmetry to your face, since with facial surgery the asymmetry would be more noticeable. I hope you consider this opinión.

Would I benefit more from fillers or a facelift? 53 y/o female concerned about symmetry, hollow eyes and flat face (photos)

Answers (9)

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