38 year old woman - facial aging, eye bags and jowls appearing, too early for surgery? (photos)

Question

I have lost weight since my last child and seeing signs of ageing and skin laxity. I am about to start a course of 3-4 full face fraxel dual treatments, with some more botox (crows feet) and some filler for my eye trough. TCA 15% peels and derma rolling. Hoping to encourage collagen production and as much natural tightening as possible. Am I too young for a mid/lower face lift and lower blepharoplasty? Would I be a good candidate for a thread lift? Perhaps Ultherapy/Thermage or Cheek implants?

Alejandro J. Quiroz, MD · Answer

After reviewing your pictures, yes you are young for a face lift but nevertheless I believe that that procedure will give you the most permanent results and I will see you as and investment. Other treatments including Thermage and Ultera will help by increasing the skin tone but this condition will continue and you will decide in a face lift soon.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. The treatments you’ve listed are favorable surgical alternatives to treating skin laxity and eye bags. For natural tightening and collagen production, you may also want to consider the benefits of RF microneedling. This treatment option uses a combination of microneedling and radiofrequency technology to encourage your body’s elastin and collagen production, allowing it to grow tighter, firmer, and smoother over time. RF microneedling can diminish fine lines and wrinkles and reduce the appearance of early jowl formation and lower face sagging. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to discuss your concerns with you and help you decide on the best approach to help you achieve your aesthetic goals.

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question and pictures. Unfortunately you do not have enough skin laxity to perform a facelift.  You could look into creating some volume in the face by dermal filler.  All The Best

Sam Speron, MD, FACS · Answer

A Mini Facelift or eyelid surgery can usually be an option on most realistic patients anytime after the age of 35-40. It really depends on your anatomy and genetics. It is best to talk to your surgeon because everybody has different techniques and recovery time is usually based on a number of factors. If we are just talking about a short scar facelift, this can typically be done in the office under local anesthesia. Usually there are no drains, no outside stitches, and patients can go out in public the same day, although I usually recommend they low for the first couple days. Most of the initial swelling is from the numbing medicine and your body absorbs it within the first 4-6 hours. Obviously the body heals with swelling and inflammation and usually that maxes out at two days and then starts getting better. Most of these patients take no pain medicine and usually feel very comfortable going out in public within a few days.  I usually call my patients the night of surgery and check on them the next day. If everything is fine the next day, I then let them shower and they do not need a dressing over their incisions. They can usually start using make up after a few days.  At the two week check up, I usually have people start working out and then after six weeks they can do whatever they want. I routinely tell people to take a few days to a week off work and to hide out but some people are very nervous especially celebrities and I usually tell them to hide out for two weeks. As with any scar on the human body, initially scars are red, hard and raised and it typically takes six months to a year for them to become a soft thin white line. Additionally with recovery, there're many things we do to expedite healing such as nerve blocks during surgery, oral supplements, skin care and scar therapy recommendations, lymphatic massage sessions that are included in our pricing.I strongly feel that it's very important to have an honest conversation with your surgeon about your particular situation, lifestyle, work environment and specifically which procedures you're having done so that you both have the most honest answer about your recovery and are realistic with expectations and results.Surgery is not for everyone. In today's day and age, there are many nonsurgical options to consider although surgery usually gets the most improvement specifically of the jowls.I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of facelifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations. I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Zoran Potparic, MD · Answer

It seems that you have planed appropriate procedures to improve your skin and delay surgical rejuvenation of face and neck. Possibly liposuction of jowls with small cannula. Good luck.

Robert E. Zaworski, MD (retired) · Answer

There is no magic age for a facelift.  Elective surgery is done when you need and want it.  You would be a candidate for a conservative natural facelift to achieve a more youthful refreshed appearance.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts on women in their thirties.  From the photos your cheeks are very flat in the front (more so on one side), jowls are present and the back portion of the jaw line is also weak.  Better close up photos of the eyes would help differentiate lower eyelid fat bags from, malar bags or indentations in the tear troughs.  These factors combine to create a long, thin, rectangularly shaped face. 
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  When the cheeks are flat or concave in the front (making the face appear elongated), the cheeks can be  augmented with precise forward placement (not off to the sides) with a dermal filler or by using silastic cheek implants (permanent enhancement) to create full, round cheeks that will feminize the entire face.
 "Jowls” are sagging facial tissues (as you demonstrate in the photos when pulling back the skin) and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. While the multiple types of "skin treatments" like micro-needling and Laser treatments have their place in skin rejuvenation, it's important to keep all of these "heavily marketed" non-invasive procedures in the proper perspective.  Non-invasive techniques typically shrink the skin several mm's.  There are 25.4 mm's in one inch.  The minimally invasive facelift described here can remove 2 to 3 inches of skin which equals 50.8 to 76.4 mm's or up to 25 times the amount of loose skin provided by non invasive techniques.  That reality should always be front and center in the decision making for prospective facelift patients.  It should also be noted that non invasive techniques have no ability to properly dissect, elevate, trim and re-suture the SMAS layer making them one dimensional at best.  And finally why fat transfer or injections should be avoided when shaping the cheeks, chin, lips or jaw line.  I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

38 year old woman - facial aging, eye bags and jowls appearing, too early for surgery? (photos)

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