47 years old. Facelift or fat grafting for sagging skin? (Photos)

Question

I am a healthy 47. I take good care of my skin and face but have noticed skin sagging in the last 2 years. My biggest concern is nerve damage, being pulled to tightly and feeling like my facial sensations will bother me. Do people feel normal again after the healing time?

Philip Wasicek, MD · Answer

Hello, 
Thank you for your question. 
In general, fat grafting does not significantly correct sagging skin and should not be used for that purpose. It is used to restore volume loss that occurs with aging. 
The most effective treatmetn to treat significant skin redundancy in the face is a facelift. I would recommend an in-person consultation with a board certified plastic surgeon who specializes in facelift surgery to best evaluate and make personalized recommendations for you. 
To answer your other questions regarding sensation changes--it can be very normal for patients to experience temporary numbness after a facelift surgery, and this very frequently returns to normal after the healing process. Sometimes it can take weeks to months. 
Hope this helps.

Kerem Sami Kaya, MD · Answer

Hello,
After the age of 40, the signs of aging can begin to progress more rapidly, depending on an individual's anatomical and physiological characteristics.
After reviewing your photographs, I can see that your jowls and nasolabial folds are becoming more noticeable as a result of midface descent and soft tissue sagging. At this stage, changes in the other areas of your face do not appear to be particularly pronounced. Your neck, especially the central neck area, also appears to be in good condition.
The facial sagging that you are experiencing can certainly be addressed with a Deep Plane Facelift. When performed by an experienced surgeon, this is a safe and well-established procedure. The facial nerves are identified and carefully protected throughout the operation.
The goal of this surgery is to achieve a natural rejuvenation without altering your facial expressions, character, or emotional appearance. When the healing process progresses as expected, patients typically return to their normal daily lives and enjoy a smooth recovery.
Kind regards,

Keshav Magge, MD · Answer

Thank you for your question.  From my patient's perspective as relayed to me- eventually all patients feel fine and don't have complaints about persistent sensations and being pulled too tight.  initially during the healing process these concerns are common- but as things heal- they generally dissipate.  Hope this helps.

Bianca Knoll, MD · Answer

thank you for posting your pictures. Facial nerve damage is a potential complication during deep plane facelift surgery - that is correct. The nerve runs close in certain areas during surgery. Knowledge about anatomy, experience, and certain safety maneuvers during surgery minimize the risk substantially. Once a surgeon focuses on repositioning  the areas who have been following gravity - rather than pulling - results of a facelift will appear naturally rejuvenated.  Looking at your pictures, I think you will have a very nice result from a deep plane face and neck lift.

Tanveer Janjua, MD · Answer

You can benefit from a deep plane face and neck lift. The edited photo that you attached shows an improved jaw line and neck contour. That can be used as a guide to achieve similar results. Remember AI generated or photoshoped images always look perfect. You need to educate yourself more on facelift surgery and get multiple consultations. 
Regards
Dr. Janjua

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Velx,

From your photos and your concerns, it looks like the main issue is early sagging in the lower face and jawline, more than just loss of volume. In cases like this, fat grafting by itself usually does not do enough to lift the skin. It can help fill hollow areas, but it does not truly tighten loose tissue. A facelift is usually better for treating sagging skin and early jowls.

Your concern about looking too tight is very common. A natural facelift should not make you look pulled or strange. When done well, it should make you look refreshed, not different. The goal is a softer, more rested look.

As for nerve damage and feeling normal again, most patients do have some numbness, tightness, and strange sensations during healing. That is expected. In most cases, those feelings improve over time, and patients do feel much more normal again as healing continues. Permanent nerve problems are uncommon, but they are still important to discuss during a consultation.

In my opinion, your concern sounds more like a lifting issue than a filling issue. Some patients do best with a facelift alone, while others benefit from a facelift with a small amount of fat grafting to improve shape and balance. The best choice depends on how much sagging you have, where volume has been lost, and what kind of result you want.

It would be worthwhile to have an in-person evaluation with a board-certified plastic surgeon who has strong experience in facial rejuvenation. That is the best way to learn what will look natural and fit your goals.

Regards,
Earl Stephenson, Jr, MD, DDS, MBA 
| Founder, ESJ Aesthetics | "Where Confidence Takes Shape™!"

Waylon Zeng, MD · Answer

Hi there thank you so much for your question and for sharing your photos. I often will hear patients say there was a very specific day or time period where they felt like they didn’t recognize themselves in the mirror anymore. Luckily, we have come a long way with facial plastic surgery to achieve really natural results! Looking at your photos, I see that you mainly have some “sagging” of the fat in your cheeks and some early jowling along the jawline. While there is a little bit of extra skin, I would say the main issue is the tissue underneath the skin. Fat transfer works great to plump up certain areas such as the cheeks, but the amount it would take to lift up all the deeper tissue and skin would not make you look natural. 
Lifting up the deeper tissue requires a form of face lift (SMAS, deep plane, endoscopic) to address the deeper tissue. The goal is to raise it back up to where it used to be: around the cheeks area. Hope that helps!

Mehmet Ozdemir, MD · Answer

Based on your photos and concerns, you appear to have mild to moderate facial laxity rather than primarily volume loss. Fat grafting can restore fullness, but it will not significantly tighten sagging skin. A facelift would likely provide the most effective improvement if skin laxity is your main concern. Fortunately, most patients regain normal sensation over time, and permanent nerve injury is uncommon when surgery is performed by an experienced facial plastic surgeon. A consultation would help determine whether a facelift alone or combined with fat grafting would give the most natural result.

Adam David Lowenstein, MD, FACS · Answer

Your two concerns about nerve safety and looking pulled are actually the most important questions to ask when evaluating facelift surgeons, and they deserve a more specific answer than most patients receive.
On nerve safety: I perform peripheral nerve surgery as a separate specialty, which gives me a different perspective on this than most facelift surgeons. The facial nerve is at greatest risk when surgeons work too superficially or without precise anatomical knowledge of where the nerve branches become more superficial in the midface. In a properly executed deep plane approach, dissection follows established anatomical planes that actually move away from the motor nerve branches rather than toward them. The risk of significant nerve injury in experienced hands is low, but the key word is experienced. Ask any surgeon you consult with how they specifically protect the facial nerve during deep plane dissection.
On looking pulled: this is almost always the result of techniques that rely on lateral skin tension to achieve the lift. A structural approach repositions the deeper tissues, including the SMAS, the retaining ligaments, and for the midface, the tissues over the cheekbone, vertically back toward where they were. When the deep tissues do the work, the skin redrapes with minimal tension. The result is rejuvenation rather than distortion. The operated look comes from pulling skin sideways, not from surgery itself.
On fat grafting: at 47 with the changes you are describing, the primary issue is structural descent, not volume loss. Fat grafting addresses hollowness but does not reposition tissues that have fallen. A structural facelift is the right tool here.  Fat grafting is wrought with long term deficiencies- think of it as a shortcut that inexperienced surgeons need when they can't properly manage the structural framework of the face.
At 47 you are actually an ideal candidate. Early enough that the tissues are still in excellent condition, the correction can be comprehensive and long-lasting.
Adam Lowenstein, MD, FACS- Montecito Plastic Surgery, Santa Barbara, CA, serving patients from San Diego, Los Angeles, and throughout Southern California.

47 years old. Facelift or fat grafting for sagging skin? (Photos)

Answers (9)

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