Age 38 - Which type of facelift to achieve desired look?

Question

Dear doctors, I am a 38-year-old woman with a slim face, experiencing loss of volume and sagging in my cheeks. I had a forehead lift and an endoscopic mid-face lift 8 months ago, but the results didn’t last, and my face now looks thinner. My skin isn’t dry, and I don’t have deep wrinkles. What procedure would you recommend to restore volume and lift my cheeks for longer-lasting results?

Ozge Ergun, MD · Answer

You need additional volume in the lower eyelid area. A cheek implant could be an option depending on your expectations. The implant can be selected to extend across both the cheeks and lower eyelid or focus solely on enhancing the lower eyelid area.

David K. Isaacs, MD, FACS · Answer

Please don’t get a facelift. I don’t care what their board certification is, how many board certifications they have, have many instagram followers they have, how catchy their TikTok account is, which famous person they’ve operated on. You don’t need a facelift nor do you need another forehead lift nor another endoscopic midface lift. You will run into issues. Easier to stay out of trouble than get out of trouble.

You can consider undereye and facial fat transfer, but in the before photo you look like you have visible lower eyelid bags and not so much in the after photo and you didn’t mention undergoing a lower blepharoplasty. But if you do have the lower eyelid bags and it’s just not seen well in the photos, you can consider transconjunctival lower blepharoplasty with fat repositioning at the same time.

Choose your surgeon carefully. Consult an expert for an evaluation. Contact me for more details! Hope this helps!

Nashielli Torres Espinosa Chiu, MD · Answer

Dear patient,
Thank you for sharing your experience and concerns. As a board-certified plastic surgeon, I understand the challenges you’re facing with volume loss and sagging in your cheeks, especially after undergoing a forehead lift and endoscopic mid-face lift eight months ago.
Based on your description, it seems that the primary issue may be a loss of facial volume rather than skin laxity. In such cases, a facial fat transfer can be an effective solution. This procedure involves harvesting fat from another part of your body, purifying it, and then injecting it into areas lacking volume, such as your cheeks and temples. This approach not only restores fullness but also provides a natural and longer-lasting result compared to synthetic fillers. ￼
It’s important to note that while fat transfer can effectively restore volume, it does not address significant skin sagging. However, in cases where volume loss is the primary concern, restoring this volume can provide a subtle lift to the skin. ￼
I recommend consulting with a board-certified plastic surgeon who specializes in facial fat grafting. They can assess your specific situation and discuss the potential benefits and considerations of this procedure in detail.

Stefan Mark Szczerba, MD · Answer

I would recommend Sculptra injections... usually about a series of 3. Consider also fat graft but in a premenopausal woman, you have to be very careful. You do look quite lifted so this could be a temporary issue- hence the recommendation of Sculptra. Best Wishes!

Ajaya Kashyap, MD · Answer

Thank you for your query. The best option for you at this time maybe to get volume restoration using your own fat or fillers rather than stretching your skin further with a surgical face lift. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns. All the best!

Jeffrey M. Darrow, MD · Answer

Your overall facial shape and contour is excellent. As you are concerned about the thinness of your face, and you have the benefit of youthful, strong, elastic skin, a mini facelift with a SMAS plication should help add additional volume and fullness to your cheeks and the plication allows stacking of the tissues to add the appearance of additional volume to your face, while minimizing the extent of your surgery. Best wishes.

Zeshaan Maan, MD · Answer

The best option for volume replacement as part of your overall facial rejuvenation strategy would fat grafting. Based on the photos you’ve provided, you appear to have only minimal jowling (though a 45 degree and profile view would be helpful for analysis), in which case a mini facelift would be effective. I suggest you have a consultation with a plastic surgeon to more completely evaluate you and agree on a plan.

Oliver Pope Simmons, MD, FACS · Answer

I don't see a huge need for a skin excision surgery. My recommendations would be to either consider small voluminization with fillers or consider a fat grafting session or two under general anesthsia.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here !My answer will be based on the limited information and pictures provided , for a personalized and detailed plan please consult with your plastic surgeon in person .From the pictures provided it does not appear that you need a facelift . If it is volume that you are seeking then I would consider fat grafting , when placed strategically it can give you a refreshed youthful look and give you more volume thus improving the thin look. depending on what percentage of it takes you might need more than one session.I hope this helps, best of luck!

Connie Hiers, MD, FACS · Answer

You have a thin face so large cheeks will just look odd and out of place. I recommend radiofrequency with micro-needling, like Secret, to help tighten and improve collagen.  Your brows area bit too high for your face, but will relax over time.