Surgery at Age 35? Superior to Fillers? (photo)

Hello, I am a 35-year old female. I use dermal fillers in the mid face, tear trough, temple and naso-labial fold area to combat post-surgical weight loss/ageing. My fillers cost approx USD3000/12-14 months. My appearance affects my job success greatly. I seek a fresh look for my money. Upon visiting a plastic surgeon, I was advised that I was wasting $ on quick fixes. He recommended a midface lift. My dermatologist disagrees. Thank you to those who answered before. I find surgery intimidating.

Doctor Answers 22

Without seeing you (and those pictures are not helpful) mid face surgery would be a big mistake.

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I do midface surgery.  I have invented midface procedures.  I use midface surgery to repair damaged eyelids after cosmetic eyelid surgery that go bad.  Midface surgery is not a reliable means of improving the cosmetic appearance of the mid face.  Your plastic surgeon many not understand this.  Mind you I fix the work of many famous plastic surgeons doing midface and eyelid surgery.  The problem is that midface anatomy is poorly understood.  How these procedures damage the surrounding tissues is even less well understood.  It is best to consider midface surgery a high risk procedure.  When the risks are justified, then it is reasonable.  For cosmetic needs, there is simply no question that the best done midface filler procedures are light years better than our very best surgical procedures.  As your budget demonstrates, these are not quick fix treatments.  They are high value, expensive services that are far more valuable than almost any surgery in the right hands.  Think about it, no surgery, no anesthesia, minimal or no down time.  If there is a problem, the treatment can be reversed or feathered with the injection of the enzyme hyaluronidase.  That is why you are spending so much for these treatments.  

Unfortunately it is not the case that having a surgery will achieve a result that is just as good as the fillers and last much longer.  I think the reality is that this is the very exceptional outcome.  Sure we still do surgery.  There are situations where the fillers and botox are no longer getting the job done or a particular anatomic situation that is just right for surgery.  Guess what, even in these circumstances, after surgery people still get the botox and filler services to make things better.

So if fillers are still working for you, there is no question that you should continue these treatments until you and your dermatologist just can't get it done this way.  At that point, I would then recommend finding a better injector.  At some point, sure, you will need surgery but based on the photos you have provided I don't think you are there yet.  Talking yourself into surgery to "save money" will prove to be very disappointing.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Facelift surgery at a young age

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I know its frustrating to repeatedly spend your money on facial fillers and its tempting to find a "permanent fix" but there really isn't one. Midface lifting procedures can reposition your midface tissues to give some volume enhancement but the results in all honesty are modest at best. Cosmetic complications and prolonged healing times are common with midface surgery and at your age I dont think its worth the risk. If your happy with the results of fillers either stick with them or consider a longer lasting augmentation with fat transfer.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Midface at age 35

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You do not need midafce surgery. Midface surgery does not work as well as many surgeons say it does. I would continue using fillers, as the are very reliable. Fat transfer is an option, but it is not as reliable as the fillers. Seeing that you are very keen on your looks, I think that you would probably continue to use fillers even after having fat transfer. For that reason, fillers are your best treatment.

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 123 reviews

Lift vs Fillers for Facial Aging

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I cannot tell exactly what you need from the picture submitted, but surgery is a more permanent solution than  temporary fillers. I'm not sure that a lift is appropriate; cheek implants may provide the projection and contour that you need.  A physician who does not do surgery is likely to recommend fillers. I suggest you get another consultation from a physician who uses all alternatives..

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Too young for mid facelift?

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I suspect that the plastic surgeon is correct in his/her evaluation and recommendations.  From what I can tell from your photos, possibly a combination of mid-face, mini-facelift and autologous fat grafting would be in order.  I suggest to my patients that they obtain a second opinion if they are at all uncomfortable with recommendations I make, and you may wish to consider this. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Jonathan Berman, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 19 reviews

Midface Lift or Fillers

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    I do not see anything in your pictures that would justify surgical intervention in the form of a lift.  If you do not like the cost paid for the fillers every year, you could consider fat grafting.  These are the two choices I offer all of my patients in your situation.  Kenneth Hughes, MD Los Angeles, CA

Midface surgery vs. noninvasive methods for rejuvenation of the face

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Thanks for your question. Fillers are a great noninvasive treatment for volume loss of the face. The classic fillers are the hyaluronic acids. Another option is Sculptra which is a different compound that stimulates your body to produce collagen in the areas injected thus providing you with a natural rejuvenating response. Fat transfer if done with the proper technique has a 60-70% chance of surviving and usually does require multiple treatments to get the best results. Fat transfer is definitely a viable option to rejuvenate the areas of concern in your face.


Midface surgery is another option and can be done do to reposition sagging cheeks back to their youthful position on the cheekbones to achieve the "heart" shaped face again.  A board certified surgeon may be able to perform an endoscopic midface lift through incisions hidden in the hairline and endoscopes as thin as a drinking straw.

 However, as others have mentioned there is a risk/benefit scenario to consider with all treatment options. From looking at the pictures I don't think midface surgery is a good option for you at this stage. If you are happy with fillers I would recommend continuing with them and thinking about other nonivasive options such as Sculptra or Fat Transfer

Best of luck,

Sachin Parikh MD

Sachin S. Parikh, MD
Bay Area Facial Plastic Surgeon

35 is probably too young for facelift of any kind.

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There are exceptions to every rule but seldom does the patient present at the age of 35 where a facelift of any type is indicated. The photograph provided fits this generalization. I would stick with fillers for the present time. One might consider some longer-lasting fillers if you don't like returning to the office so often.

Bridge to the lift

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Sculptra is the right choice for you at this time. It will give you new natural collagen over a large area that will rejuvenate for years. A moderate CO2 laser resurfacing will renew your overlying skin. Together these will give you a refreshed very presentable appearance. 

Justin Yovino, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 103 reviews

Surgery or fillers?

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I perform many midface lifts and would not recommend it to you. You could consider cheek implants if you were looking for a long lasting (much longer) solution, albeit surgery. You might also consider other fillers such as either fat or Sculptra which last longer. Good luck.

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.