42 years old and starting to see my face aging. What face procedure would be recommended? (Photo)

Question

I am 42 years old and really starting to see my face aging and I'm wondering what procedures would benefit me most? Both photos were taken this week- one with makeup and one without. No filters- lighting adjustment only.

Marc Polacco, MD · Answer

Thank you for your question. As we age tissue descends, and this occurs in conjunction with volume loss. Thus I find addressing both tends to give the best result. Typically a facelift is the best procedure for addressing the cheek and jowl region, while volume can be addressed using implants, fillers, or fat injection. Each carries different benefits and downsides, and it's important to review each before moving forward. I hope that helps, and all the best.
Dr. P

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Nima Shemirani, MD · Answer

Hi @TennesseeJule! I recommend starting off with Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Danielle Shanley, MD · Answer

Hi and thank you for your question.  Morpheus stimulates the production of collagen and resurfaces skin for a more younger looking appearance.  It is minimally invasive, using a matrix of micro pins to renew the deeper layers of the skin.   I would consult with your physician to come up with a proper treatment plan for you.

Nelson Lee Novick, MD · Answer

Starting from the top, the "eleven" (frown) lines between the eyebrows can be easily treated with Botox (for the dynamic component) and if there is any residual creasing at rest (the static component), superficially placed filler would help to elevate and smooth this. A more robust filler can be used for the cheeks to help lift and volumize them, which would not only achieve a more oval face but diminish the tear troughs below the eyes and the smile lines below. And voila, an entirely nonsurgical rejuvenation that can be achieved in about 15 to twenty minutes in experienced hands. Make sure that you consult a board certified cosmetic dermatologist and best of luck.

Nhi Le, MD · Answer

Start booking microneedling facial with peptides or PRP regularly to boost skin collagen and reduce sagging and pores and wrinkles! Try Botox in your upper face for a refreshed look! Try HA fillers in your laughing lines, cheeks, and under eyes! Pdo threads also achieve lifting and youthfulness!

Richard Ort, MD · Answer

I would start with Botox to the glabella (frown) lines and consider adding some fillers to the cheeks. 
Regards,
Dr. Ort

Sergio Guiteau, MD · Answer

Hello,
Thank you for your question. You have asked a general question to a lot of providers and will probably get a variety of responses since everyone's technique, experience, and skill level can vary in regards to aesthetic procedures. There is no right or wrong answer and this area is truly where medicine meets art. There is also a range in cost for these procedures and so I am not exactly sure how important the cost of these different procedures are for you. Lastly, I am also not sure what other medical conditions, allergies, or prior surgeries you may have had so I will assume you have no prior history of any of these for simplicity.
I can only speak from my experience as it relates to your nonsurgical options as a provider who specializes in Neurotoxins (like Botox), Dermal Fillers, PRP, micro-needling, and PDO threading. 
Based on the photos you provided I think you may benefit from neurotoxin for forehead wrinkles, crows feet, and frown lines between the eyebrows. The sooner your start, the more likely you are to prevent the progression of wrinkles in these areas. If you were open to using dermal fillers I would consider augmenting the area around your cheekbones to add a subtle lift and enhance the volume of the area around your midface. In aesthetics, we sometimes refer to this as the OGee curve. Often times you can straighten the jawline with dermal filler as well to add a more youthful angle to the jawline and reduce the signs of jowling. This is the skin that begins to sag near the front part of the jawline. I would however have to see more pictures of this area to see if this might help. Likewise, you can also use PDO threading to get a lift of cheeks (midface) or jawline (lowerface). PDO threading will cost more but will likely give you a better "lift effect" than fillers. Lastly, you are likely to benefit from some sort of skin rejuvenation technique that involves PRP, micro-needling, or a combination of both. They will both induce collagen production and can help give you a subtle lift appearance. You may also notice a decrease in any skin tone unevenness or blemishes. 
These are only places I would consider and as such are also only places I would start given the photos you provided. You may benefit from more procedures or techniques however I can only respond based of the 2 photos you have provided. I would certainly speak to a provider to have a more detailed discussion of what might work best for you.
Best of luck! :-)

Robinson Facial Plastic Surgery - Alpharetta · Answer

Good afternoon! Thank you for your question. You are undoubtedly a beautiful woman, but as you said, you are aging, and a little maintenance is required. A couple of simple things you can do that will give you quick and notable results are to get a little Botox or Dysport between the brows, and some filler in the mid face, to give you a little pick-me-up. You are starting to get lines, between the brows, that are becoming etched in your skin. This not only gives the appearance of an aging face, but sometimes is perceived as you being sad or even angry. This is something you want to nip in the bud, before the lines become so deep that they will not go away. You have really nice, full cheeks, but they are starting to fall a little bit, which makes you look a little tired. Adding filler to the cheeks, will help soften the crease in the middle of the cheek, the hollowing under the eyes, and the laugh lines. Sometimes a little filler needs to be added directly under the eyes, but I would start with the cheeks. This will give you a more youthful and refreshed appearance. Lastly, make sure to use good skincare, and sun protection. This will ensure your skin looks radiant for years to come. I hope this helps!

Darryl J. Blinski, MD · Answer

Thanks for the interesting posted photos. I recommend in person or virtual consults. I would offer full rhinoplasty, upper lid bleharoplasty, mini FL/NL SMAS, HA fillers or nano fat grafting. Fees in $25,000 ranges.

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