I'm 46 & unsure if I am ready for a mini facelift or other surgery? Currently use Botox in forehead and some restylane (Photos)

I am unsure if I am ready for a mini facelift or surgery under my eyes. I have significant crinkling under eyes when smiling (but not when face is at rest), some skin laxity in lower face and feel like my face is mildly sagging. I use Botox in forehead and have used restalyne once in lines between mouth and nose. I'm 46 and not sure what my next options should be.

Doctor Answers 25

Mini lift

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A mini lift with a high SMAS technique would be a good procedure for you.  It would give you cheek fullness and eliminate the fullness in the jowl region and the excess skin in your neck and under your chin.  A pinch lower lid blepharoplasty can be added to correct excess lower lid skin.  Best wishes, Dr. T. 

The are modern non-surgical aging treatments that can be used with or without lifting procedures

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Thank you for your question. You’re 46-years-old and submitted several very good photos describing  some crinkling under your eyes when you smile. You indicate you had treatment with Botox™ and Restylane in the past, and you are considering surgery for your lower face due to skin laxity.

I can certainly give you some opinions about how I approach people like yourself in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon in practice in Manhattan and Long Island for over 20 years.  I specialize in procedures to help people with facial aging. In fact, I have written books about it and I’ve been a source for media regarding this topic. Over the course of 20 years, I’ve personally gone through many different  evolutions with the approaches I have for people like yourself.

First, it is important you understand some basic principles, because doctors and non-doctors will offer you all kinds of solutions from their bag of options. At the age of 46, you are dealing with two things related to facial aging: volume loss where you lose bone, muscle and fat, where a few millimeters of bone loss can actually be a couple hundred milliliters in actual volume loss; and laxity or loosening of the skin where tissue that supports the face and the skin get thinner.

A few years ago, we would have discussed options such as limited facelifts, but nowadays, with someone yourself, I try to figure out when is the right time to do surgery, and when is not the right time. I think we would probably address some of these issues with a combination of something called structural volumizing. Structural volumizing is an approach where fillers such as Restylane you are familiar with, but with something thicker and more substantial like Juvederm Ultra Plus, Voluma, or Restylane Lyft would be applied in a way to reach bone level, which is a deeper than where fillers are generally placed. This restores some of that lost volume, and also restores angles and projections that can look very natural. It can actually look like you’ve had a facelift because we are adding volume to structure, hence structural volumizing.

We also have different options to help skin quality, including platelet-rich plasma (PRP), fractional laser treatments, non-surgical skin tightening using 1064 YAG laser for dermal tightening, and deep tissue tightening. Even for a surgeon like myself, these new options helps me do the things I can’t do with surgery, or do it in a way to optimize the results. When surgery is indicated, surgery is appropriate, but I find a lot of people in their 40s benefit from this type of approach. Sometimes there is a blended approach such as a procedure called the Beauty Lift® where we combine limited face lifting with structural volumizing. As you can see, there are a lot of ways to approach this issue.

You’ll find that as you do your research, people will be coming at you with all kinds of ideas,so you have to figure out what makes sense to you and what you are comfortable with. Never get sold on a single solution. It is very important to understand that in the aesthetic field, there are a lot of people selling a lot of things. As a veteran, as an experienced cosmetic surgeon where I offer everything from skin products, to minimally invasive, to lasers, to advanced surgery, what we figure out is how to help our patients optimize their solutions. Learn more about your options. Think about the idea of volume correction at the structural level, and some skin quality improvement. This is the age of maintenance, and it can make a real difference if you are committed to doing these things.I hope that was helpful, I wish you the best of luck and thank you for your question.

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Mini Facelift for Early Sagging

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A facelift can definitely improve your jowls and neck.  From the photos, I would suggest a less aggressive procedure than a more aggressive one (mini vs full ).  This can be discussed with your plastic surgeon.  Since you are young and don’t have severe jowls or much excess in your neck, a less aggressive procedure would give you a great result with minimal recovery.  Other options include radiofrequency skin tightening procedures but these would certainly not give you the results that a surgical procedure will.  

Potential Facelift

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Thanks so much for your question. These concerns are not uncommon, and can certainly be addressed with a variety of treatment options. I recommend scheduling a consultation with a board certified facial plastic surgeon who can assess you in person and make the best recommendation. Based on what you have described it sounds like you could potentially be a good candidate for both surgical treatments (like a facelift) or perhaps non-surgical options (such as Ulthera or laser treatments) depending on what you are ready for. During a consultation you can discuss the benefits of both surgical and non-surgical options and decide what’s right for you at this stage in your life. 

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

I'm 46 & unsure if I am ready for a mini facelift or other surgery? Currently use Botox in forehead and some restylane

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Your facial skin and appearance looks excellent and you do not need a facelift.  A blepharoplasty to correct the skin of the upper and lower eyelid followed by Botox treatments for the orbicularis oris oculi muscles in my opinion would be her best option for a younger look.

I want to look more refreshed!

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Your question is a good one and one that really brings to the forefront exactly what plastic surgery should be accomplishing.  Though you are only 46 years of age you have concerns with how your face is aging and likely have always liked the way you looked and want to maintain your youthful and vibrant appearance.  The issues that concern you with regards to facial aging can all be addressed in a conservative yet effective manner.  You may only require laser or chemical peels to tighten the skin of your lower eyelids.  You will likely continue to use Botox or other neuromodulators for the crow's feet at the sides of your eyes.  A mini facelift is an excellent procedure for patients who demonstrate early jowling or facial skin laxity.  You might consider fat injections to your face and especially your mid face to improve the volume of your cheeks and brow.  A visit with a reputable surgeon  who utilizes both invasive and non invasive techniques for facial rejuvenation will be extremely informative.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Facelifting #woundhealing #cosmeticsurgery #BOTOX #tmbcosmeticsurgery

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Dear Jlerner
Thank you for your question and photos!  You ask a very good question- but only you can answer!! It depends on your goals and the changes you want to see- how long you want the changes to last.
With Warm RegardsTrevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Facelift at Age 46?

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You are currently entering the realm of subjectivity, because the answer really depends on what you think and what your goals are.  I will tell you that I am seeing more women seeking surgical options at a younger age, after feeling that minimally invasive options were not addressing their concerns.  I have included a link below to the experience of one of my patients at the same age.However, there are a range of great options such as facial volume addition to the face which can be of great benefit at this juncture.  I recommend that you see an experience facial Plastic Surgeon or Plastic Surgeon with an interest in facial rejuvenation to take you further in this discussion. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Face lift at 46?

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Thank you for asking about your face lift.
  • You are on the right track - a lower face and neck lift (often called a mini-lift) would make a big difference.
  • These lifts done in someone your age tend to have excellent and long lasting results.
  • Surgery won't help the lines under your eyes - the treatment is easier than surgery - Botox.
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Minilift may be your answer

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I see that you are starting to get an early jowl. Depending on your physical examination, you may be a great candidate for a minilift. These can be performed in the office using local anesthetic. A minilift will get rid of the jowl and make the front view have a narrower lower face. It's very rejuvenating, very natural appearing, and very long lasting. See someone with extensive experience. Ideally, someone who specializes in aging face surgery.
Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

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