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

Question

I am noticing that my face is dropping and one day will fall on the ground!!!! I am 48 and look much older that my counterparts. I have searching and searching for a solution but this is only increasing my confusion. Face lift, mini face lift, injections, fillings and lately face tite I really appreciate your kind opinion regards Juamer

Jonathan Kulbersh, MD · Answer

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.

J. Jason Wendel, MD, FACS · Answer

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.

Kenneth D. Steinsapir, MD · Answer

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.

Richard J. Brown, MD · Answer

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.

John Frodel, MD · Answer

After looking at your photo's I think you could benefit from the following fillers:

	
		Radiasse
	
		Sculptra
	
		Juvederm
	
		Restylane


	And of course, with a mid face lift to pull up the neck and lower face.  You need to be examined by a Facial Plastic Surgeon to talk about scars and expectations.

	
		Of course, lasers would get some retraction of the skin along with some better texture.


	Hope this helps...

Stephen Weber MD, FACS · Answer

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

Kamran Jafri, MD · Answer

Hi Juamer,

	Based only on your pictures I think that a good start would be to have a "mini" necklift or platysmaplsty done.  That would improve the appearance of your profile and the loose skin that is evident under your chin.

	Certainly looks like you have early sagging along the jaw line but a face lift might very well result in making your jaw line too feminine (a heart shaped face works for women but not for men).  Also given the short length of your hair the incision placement and post surgical appearance of scars from a face lift can be an issue for you.

	Consider some type of facial skin resurfacing like laser treatments or chemical peels. This can provide a refreshed and rejuvenated look to your skin.

	Also some Botox to the area between your eyebrows would help "open the area up" and provide a relaxed and youthful look.

	These "little" procedures can add up to give you a whole new rejuvenated look without resulting in an unnatural or overly pulled look.

	Good luck to you,

	Dr. Kamran Jafri

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question. A Facelift will improve the sagging of the cheeks, jawline and neck in particular. Because you do not have full hair, care and expertise is necessary to hide your Facelift Scars.

	Only a Facelift or Neck Lift will tighten your neck line.

	Filler Injection such as Perlane, Sculptra or Radiesse or Fat Injection will give you a nice improvement in your cheeks without surgery.

	However only surgery will improve your neck.

Francis R. Palmer, III, MD (retired) · Answer

Aestheically speaking, from the photos provided, the cheeks are very flat which has allowed the midface to sag unabaited towards the nose and mouth.  The chin is also weak which has created an excess of skin in the center, of the neck.  The lower eyelids also show evidence of herniated fat.  

	 A minimal Incision facelift "Celebrity Facelift" combined with Cheek Augmentation, Chin Augmentation, sub-mental skin ellipse and a lower Eyelid Surgery would seem appropriate to create a more naturally youthful, masculine and attractive face.

	 The beauty of the minimal incision Face Lift is that it takes about 90 minutes, uses smaller incisions that do not extend into any of the hair-bearing scalp and has a much faster recovery time that's measured in days.  Hope this helps.

Sheldon S. Kabaker, MD FACS (retired) · Answer

The major aging feature of your face based on these photos is what appears to be lipoatrophy. This is often associated with certain medical treatments, weight loss or heredity. A combination of facial filling along with tightening rocedures (face lift, nasolabial fold excision) may work for you.

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