Saggy Face At 48. What Can I Do? (photo)

You are a great example that aging occurs in 3 dimensions.  Not only do you have sagging skin, but you have significant volume loss to the face.  I believe you would benefit from both a lift and fill of the face.   Depending on your concerns, you could have a neck or facelift to define the neck and jawline.  For the remainder of the face, you need volume.  This could be achieved during surgery with facial fat transfer or facial implants.  You could have volume added to the face with in office fillers.  It is a personal choice which approach to take.  You have many options so a consult with a few doctors would be helpful.

Thank you for you question and the photos. You are going to get many different answers for your question.

You could get a lot of benefit from fractionated resurfacing followed later by filler or fat transfer.

Others will have differing opinions.

To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

The most striking issue apparent in your photos is volume loss in the middle and lower face. This can be remedied with injections of dermal filler material, Radiesse, Scuulptra or fat transfer. This will remedy much of the atrophy of your facial tissue. Volume is the best place to start. This can always be followed with laser resurfacing or surgery to tighten the skin but the primary issue that you're noting is loss of facial volume. I hope this information is helpful.Stephen Weber MD, FACS

You also demonstrate significant loss of volume in the cheeks and the reality is that facial fillers alone could also make a significant difference.  I recommend that you do your home work and find the highly qualified surgeons in your area and seek several opinions.  Someone will make sense to you and this will be your surgeon.

You exhibit so many of the features that everyone of us will have over time. Gravity wins! You have lost mostly the midface volume that you once had higher over the cheek bones. From top to bottom here are many things you could do. neurtoxin such as Botox or Dysport to help with lines in the forehead and between the eyes. You could also benefit from lower eyelid surgery to alleviate the tired look with bags that we all get. I can not tell if you need upper eyelid surgery or eyebrow surgery unless I can examine you. You need restoration of volume in the cheeks which can be done with filler or fat transfer. You would also have a nice result with a facelift and necklift. For overall longevity of results you should be using some type of skin care products and seeing an esthetician for upkeep especially to prepare for surgery and to continue after surgery. Investing in your face and its long term upkeep is important if you choose to have cosmetic facial surgery.