Ready for a lift this year and would like to know if I should do it at the same time as an upper blepharoplasty? (Photos)

Yes you are likely candidate for upper blepharoplasty. It is important to have personal evaluation to determine realistic results and see an expert for safe, natural results.

You're still relatively young and expensive, aggressive surgeries that engender postsurgical downtime should be postponed as long as possible. In keeping with the "Keep It Simple" rule, it would seem to me that a nonsurgical filler rejuvenation should be at the top of your considerations, rather than out of the picture altogether. For one, the photos suggest some volume deficit in the lateral brow region and a robust lifting filler, such as Restylane Lyft, could be used enhance the very desirable female upward and outward flare of the lateral third of the brows. A robust volumzing filler, such as Voluma XC, can not only help to create desirable upper cheek projection, but secondarily help to diminish the incipient smile lines to the sides of the nose and tear troughs and hollows under the eyes. Finally, a lifting filler to the elevate and smooth the mental crease (the horizontal linear indentation above the chin and below the lower lip) will not only improve the appearance of this region, but will also impart a more sensual pout to the lower lip. Voluma XC can also be used to augment chin projection and create greater harmony in profile view between the projections of the nose, lips and chin. You would be wise to consult with an experienced, board certified cosmetic dermatologist to discuss these nonsurgical options whose results following treatment typically engender an immediate "Wow!" reaction. Surgery, maybe--in ten or more years--but likely by then we'll have completely new non-surgical, prescription topical creams and lotions that will truly penetrate the skin (unlike today's OTC products) to stimulate new collagen and new elastic fiber synthesis and restore volume without even the need for injections. And we will likely truly have machines and devices to do this, as well, unlike the unproven and heavily hyped and marketed fraxel lasers and radiofrequency devices being hawked today. Hope this helps. Best of luck.

Everyone ages at a different rate. Some patients at 48 have more aging than those much older. It depends on numerous factors including: heredity, history of smoking, lifestyle, sun exposure, excessive exercising, underlying medical health, and significant weight loss. It makes sense to do it at the same time and avoid two anesthesias and two recovery sessions.

In the past, it was felt that 48 would be too young to have a facelift. Now most experienced artistic plastic surgeons would feel differently. It really depends more on the extent of aging and the individualized approach that is necessary to achieve a natural appearing improvement. Since every patient is different, the approach to facial rejuvenation (fillers, micro-fat grafts, mini facelifts, facelifts, and combination of procedures) needs to be individualized in order to achieve a natural appearing improvement.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California