My face is sagging. What procedures am I a candidate for? (Photo)

Dear lillieliny,
Thanks for the question. A facelift and neck lift would remove excess skin in the neck and jowls. Fat grafting and fillers may help replace volume. I would suggest a consultation with a board-certified plastic surgeon for further information and recommendations.

Hello, As it seems like you dont have too much skin excess, I would recommend a combination of buccal fat removal, fat injection to upper&front cheeks, and a temporal lift to lift the cheek volume higher (eyebrows at the same time If desired) instead of classic approach of face&neck lift. The advantage of this combination is lifting the lower volume to a higher position without a visible scar. A face&neck lift approach is also an option, in that case I would recommend a high-smas technique to enhance the upper cheek volume on the zygoma. Regards

Honestly, I don't see much "sagging" of skin that would warrant a facelift. There is noticeable asymmetry with your right upper cheek flatter than the left.. This could be due to a combination of some normal fat loss following grafting and also the effect of the ultherapy heat on the fat. Regardless of the cause, my opinion is that correcting the asymmetry will help you best, and careful addition of volume in the right cheek will help. But first, I think you should discuss very specifically with your surgeon just what your problems and goals are. What type of shape are you hoping for. Adding fat volume will fill out the flattened area on right cheek, but that will widen your upper face slightly. Perhaps removing buccal fat in the lower cheek will create a more heart shaped face, which is a youthful look.

I’m not surprised that filllers and ultherary were useless. To me you appear too young for a facelift or any other surgery on your face

I appreciate your concerns Lillie however, it is hard to make a reasonable recommendation using your submitted photos. Also, your age would be helpful. I have never been a fan of Ultherapy because of results such as yours, and the fact that it rarely works consistently. It appears that your skin integrity is still pretty good and further fat grafting may be all you need. Another option may be MACS MiniFacelift with or without fat grafting. Come see me or another board-certified plastic surgeon in our area to explore the best options for you. Best of luck!

A deep plane, facelift surgery would definitely be an option for you. This combined with facial fat grafting can give you a balanced look, rejuvenating the face and making it look natural. 

Thank you for your photos! Thanks to the advent of new technologies we can do a lot less and achieve more positive, natural-looking results. With a mini-lift, only the lower face-- from cheek to chin-- is lifted, which effectively eliminates jowls and redefines the cheekbones. As with a face-lift, the mini- lift is often accompanied by a neck lift, which removes fat from below the chin and tightens the neck's platysma muscles, all though a tiny incision under the chin. The best candidates for the mini-lift are those who are unhappy with the contour of their lower face and neck, and whose skin has good resiliency. Additionally, an effective non-surgical option that might benefit you is Thermage. Thermage is a non-invasive (no incision!) treatment that can tighten skin, renew facial contours, and stimulate your body to make healthier collagen. The procedure uses radiofrequency technology that has been clinically proven to tighten and gently lift skin to smooth out wrinkles and renew facial contours. Fast and easy, Thermage requires no downtime from normal activities. You may also be a candidate for a Threadlift. A non-surgical face-lift that is minimally invasive and addresses signs of aging in the face, including droopiness of the skin of the brow, cheeks, jowls, and neck without incisions or scars. The procedure can be performed using local anesthesia, and most patients can return to normal activities the next day. There are a number of other options to help with facial lines. Liquid Facelift uses advanced techniques to gently lift, soften lines, and contour facial features without surgery and little downtime. Fillers such as Juvederm, Volbella, Voluma, Radiesse, Sculptra, and even your own fat can lift your skin and recontour your face restoring a more youthful appearance. Lips that thin with aging can be made plumper and more kissable, fine lines around the lips be reduced, and volume added to your cheeks to improve contour. I suggest making an appointment with a board-certified plastic surgeon to discuss your options.

You need to submit better photos showing your whole face and neck. Otherwise, meet with a board- certified plastic surgeon and discussing your concerns and options.

Based on the information you provided, it seems like you are experiencing some concerns with sagging and loss of fat in your face after undergoing fat grafting and ultherapy. Both procedures can have different effects on the face, and the specific outcomes can vary depending on various factors.

If you feel that your face is sagging and the fat has been depleted, a face or neck lift might be options to consider. These surgical procedures aim to tighten and lift the skin, addressing sagging and excess skin. A consultation with a board-certified plastic surgeon would be beneficial to determine if you are a suitable candidate for these procedures.

Regarding fat grafting, it is possible that reintroducing fat into the areas where it has been lost could provide some improvement in volume and help with lifting the face. However, the success of fat grafting depends on factors such as the quality of the existing skin and the ability of the fat to survive.

As a board certified plastic surgeon, I have always been skeptical about Ultherapy. Filler is more predictable than fat. Neither should “stretch” your face so I am compelled to wonder whether you were treated at a medispa rather than by a physician. I do not see indications for a neck lift although it is difficult to ascertain from the photos. For early facial laxity, I have had success with the Threadlift procedure which is cost effective. That said, it is important to assess skin laxity in person.