Former Sun Worshipper. Looking Old Way Before my Time. I Used to Be Pretty. I Am Tired of Looking TIRED and ANGRY? (photo)

My friends and family tell me that I don't look my age. They are just being kind. In less than a year I have had a hystrectomy and an excisional breast biopsy. I look ten years older than I did just a year ago. Depressed to the point that I have contempalted the unthinkable. Time for a facelift? I am only 44. Please be kind.

Doctor Answers 32

Surgery is Not the Answer Now

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First I would try to receive treatment for your depression by a professional.  A good emotional  state can change many things.  In the meanwhile protect and take care of your skin by not worshiping the sun and develop a good skin routine (sunscreen, Retin-A and a Moisturizure).

Dr. ES

Former Sun Worshipper. Looking Old Way Before my Time. I Used to Be Pretty. I Am Tired of Looking TIRED and ANGRY? (photo)

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You still look great, but there's more going on than just what's on your face. It sounds like you've gone through a lot and need to discuss your emotions with a professional. You may find that improving your psychological state will reflect outwardly, making surgery unnecessaryou still look great, but there's more going on than just what's on your face.

Premature aging and need for a facelift.

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Facial aging progresses as the result of the 3 basic processes.  I have termed these and the 3 D's of Facial Aging:

  • Deterioration of the skin surface.  During youth our skin is smooth, uniformly colored, shiny and transluscent.  As we age the skin surface takes on a coarse, wrinkled, dull look with uneven color (brown and red spots).
  • Deflation of facial volume.  Aging is accompanied by loss of volume at all the facial layers (skin, subcutaneous fat, muscle and bone) although fat loss has by far the greatest impact.  Volume loss results in the appearance of grooves, depressions and folds in addition to an overall change in facial shape.
  • Descent of facial soft tissues.  Over time the weakening soft tissue structure gives way to gravity and results in sagging seen at all levels:  eyelids, cheek mounds, nasolabial folds, jowls and neck waddle.

Once we determine which of the 3 D's of aging are at work in a given face, we can then individualize and prioritize between all of the options available to rejuvenate the face.  The various treatment options can be grouped into the 3 R's of facial rejuvenation:

  • Resurfacing of the skin surface.  A multitude of treatment options geared towards reversing the deterioration changes listed above (microdermabrasion or dermaplaning, chemical peels, Fotofacial IPL, fractional CO2 laser, home skin care etc.)
  • Revolumization using either off-the-shelf dermal filler or micro fat transfer.
  • Repositioning sagging tissue using surgical lifting techniques (forehead-brow lift, midface lift, eyelid surgery, face-neck lift, submentoplasty).

In your particular situation, the degree of facial aging would appaear in-keeping with your stated age and excellent rejuvenation should be possible with fairly simple, less invasive treatment options.  Consult with trusted surgeons to discuss a global treatment plan.


Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Your tissue is still strong, so a natural and younger look can be achieved by balancing non-surgical and surgical treatments

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You are one of the many women who had a hysterectomy and feel like you look older. A lot of them feel that it accelerated their aging process and they're desperate to understand which way to go. Unfortunately, they’ll get conflicting ideas and information. Some will say that the dermatologist recommended that they get injectables and the plastic surgeon says they get a lift.

I explain in my book, “The Fine Art of Looking Younger,” that facial aging has two processes: one is descent or sagging and the other is volume loss. You’ll lose bone, muscle and fat. You mentioned in your question that you look tired and angry. With the many photos you submitted, you notice when you smile, the cheek area looks so full and you look younger, your jawline looks more defined and everything looks good. Without recommending that you smile all day, it gives you an idea that when you move things upward it has a big impact on your face.

I think you would benefit from the modern combination of volume loss options including fillers such as Restylane. For the dermal lines, a Radiesse injection would help and Sculptra for the deeper volume loss. Botox and Dysport will also be needed for the frown lines and other areas where the dynamic activities of the muscles are causing these lines to occur. If at rest, your jawline and neck looks better when you lift your skin, then you may be a candidate for some type of lifting procedure. You need to clear your mind of one set of procedures displacing or replacing the other set. The art of helping people look young is balancing surgical, non-surgical or minimally invasive procedures in a way that retains the character of your face.

Other options that we offer that I have used successfully include fat transfer. This is transferring fat from one area to your cheeks. People also use term stem cells a lot these days and in my opinion, I think a lot of this field’s future lies in stem cells and hormone replacement, but that’s a different type of discussion.

I tell my patients that I’m not only a technically capable surgeon, but I’m their beauty doctor. I try to guide them through all their options. You need someone who has all the capabilities to do the non-surgical, the minimally invasive and the advanced surgical procedures so that there’s no intrinsic bias and prejudice. You don’t necessarily have to do everything at once but you should prioritize your options well.  I hope this was helpful to you, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Cosmetic Surgery is an Art and a Science

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Looking at your photos, I see only moderate aging changes. In my experience, eyelid lifts and modified facelifts do well in your age group. Try to get a better outlook on life, counseling. Depression does affect your appearance. Get a consult with a board certified plastic surgeon. All the best

Early aging can be treated with injectables.

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The photograph demonstrates an attractive face with some early signs of aging. One can make a case for doing facelift but if the patient is not ready Botox for expression lines and filler for contour irregularities are a good alternative. The good news is the skin appears to be in good condition.

When is it time for a facelift?

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Looking at your photos, you do not have a great amount of sagging skin. Improving the appearance of sagging skin is the primary focus of a facelift. Side profile photos and/or an in-person assessment would really be necessary to give you the most accurate advice. There are also variations of the facelift that may be more suitable for patients who do not need to take advantage of a full facelift. There are two main options to consider when deciding to have a facelift:

1) Traditional facelift: a great option for a patient with more advanced signs of aging who wants to refresh their neck, jawline, and cheeks.
2) Mini facelift: A less invasive facelift that rejuvenates the lower third of the face, including the jowls and neck.

There are also  a variety of additional procedures that can be used in conjunction with a facelift or mini facelift to achieve optimal results. These options include but are not limited to:

1) Liposuction of the jowl or neck
2) Fat transfer to the face
3) Cheek implants

Technique varies from surgeon to surgeon, and one can only tell what would be best for you following a thorough exam. Thanks and I hope this helps!

Time for a Facelift?

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Dear tmcdowell, you have a beautiful face!  You have thick skin so despite the years of sun worshipping you mentioned you do not have many signs of brown spots or intrinsic facial lines.  You do have strong facial muscles demonstrated by the vertical lines in the area between the eyebrows.  This is best treated with Botox.  Altering the proportions of your face will give you a more youthful balance and shape to the face.  In youth the middle third of the face in the area of the cheeks is the widest part of the face.  As we age the lower face and jowls become the area of greatest width.  Adding volume to the midfacial area with either fillers or fat transfer can recreate this youthful contour and enhance the face while being minimally invasive and effective.


Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Facial rejuvenation

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You should have a in-depth consultation with a board-certified plastic surgeon.  Objectively speaking, I think most of your facial appearance is dominated by the dynamic wrinkling of your glabellar region between your brows. Botox would be a good start to see how this affects your face. However, the other obvious difference between your photos is the fact that you are smiling in the more youthful photos. Smiling makes people look younger... and, of course, happier.

Robin T. W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Former Sun Worshipper. Looking Old Way Before my Time. I Used to Be Pretty. I Am Tired of Looking TIRED and ANGRY? (photo)

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There are many procedures available to address your concerns, some are less invasive than others.  It would be best for you to see a qualified physician to discuss your particular choices. 

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.