My mid and lower face is falling down. What can I do to restore my lost volume and firmness?

Hi Elizabeth,Most women as they approach the half century mark start to show signs of mid and lower face "drooping".  As a general statement, in my experience, I have found that the jawline and neck tend to age faster than the rest of the face.  So if you are aging like the average woman, we would expect your lower face to show signs of sagging.  If fillers did not produce any reasonable results, then we should presume that a minor surgical procedure would be a reasonable avenue to take.  First off, I would consult with another facial plastic surgeon to reassess your readiness (or not) for a lower facelift.  Many women in their 40s are wonderful candidates for a "mini lift" where the jowls and upper portion of the neck can be tightened to reestablish their facial shape (the recovery time would be less than a traditional facelift and the jawline result (and longevity) should be just as long as a regular facelift if performed by a seasoned surgeon).  Another option would be fat grafting.  If your midface (ie cheek hollows or actual cheeks) is changing and becoming thin, then placing fat in those areas may be a solid option.  Fat grafting is fantastic since it is a much more permanent solution versus artificial filler.  Again, I would consult with another plastic surgeon to at least get a second opinion.  Best of luck to you!

In our practice, we perform a non-surgical face lift / skin resurfacing treatment using Renuvion Helium Plasma Radiofrequency. ​To get the most improvement with skin tightening, we combine Renuvion (formerly J-Plasma) with lasers (Fraxel, Clear + Brilliant, CO2), microneedling/PRP, Ultherapy and InMode FaceTite. I suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer​​​​

There are various types of facelift procedures that can be helpful to different age groups. A mini-facelift working on SMAS and minimal scar can help a young patient with lower face sagging (early jowls) however an older patient with sagging of the brows, midface and neck would require a full face and necklift. A facelift procedure involving pulling the SMAS should be performed for best results on the jowls. I personally in many among other techniques use the composite facelift or high-smas facelift technique where a SMAS flap is elevated, quick recovery and very long lasting result. Some parts can also be filled with fat grafting (Lift & Fill) to enhance to overall result and make you look even younger. 
In general I advice my young patients to undergo preventative care procedures. These include regular botox injections, fat grafting if a depletion in volume is starting to occur and superficial skin tightening procedures that DO NOT damage the underlying tissue (a good option is needle RF). While these procedures usually make the younger patient looking for facial rejuvenation happy, not all will be satisfied if the deformities are severe (regardless of age). As a rule of thumb, if there is sagging of tissues and excess skin, a facelift operation is inevitable!!
Hope this helps,
Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

Thank you for your question.  Unfortunately without examination its very hard to suggest whether non surgical or surgical route would be best for you.  The only permanent solution would to sagging skin which has lost elasticity would be to remove the excess.  If you wanted volume restored then fat transplant, dermal fillers would be good solution.  Not all facelifts are very invasive.  I perform my Concept Facelift under a local anaesthetic which minimises the downtime therefore being able to return back to a daily routine within a 1-2 weeks.  Typically with a traditional facelift this would mean being bruising for 4-6 weeks after.  Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.  All The Bes

I think your comment "sculptra treatments have netted zero results and have cost me $1,500 so far" really gives you the answer. Theoretically, you may get suggestions for facelifts, fat grafts, Ultherapy, lasers, fillers, implants, etc. However, it is clear you need to do the following.1. Either send several photographs (the surgeon can tell you which angles) to one of the trusted RealSelf surgeons for advice, or post them with your question.OR2. Seek an opinion from someone who performs surgery as well as fat grafts, fillers and uses lasers: there are many well-qualified surgeons who have experience with all of these treatments. This way, you won't all into the trap of being treated with only what the particular SPA or physician does. By doing one of these two things, you will obtain relevant advice which will allow you to take the next step.Good luck to you: there are excellent surgeons close to where you are located. Take advantage of them!Prof. Bhupendra C. K. Patel MD, FRCS

While it is difficult to give you advice without having evaluated you, given that your concerns include lack of volume in your mid-face and loss of firmness in your lower face, you may be a candidate for both procedures. Fat transfer is a great procedure for many individuals with loss of volume in the face, particularly the mid-face. While fat transfer replaces youthful contours, it does not necessarily tighten the skin or return a sense of firmness to the facial tissues. Ultherapy would be a good non-surgical option to achieve some subtle tightening of the skin and underlying tissues. 

Facial rejeuvenation is a complex process that is best treated by an experienced board certified plastic surgeon who can offer the full array of procedures that can be done to improve your face. Sounds like repositioning your facial tissue would benefit you. There are many techniques that can achieve this, I prefer the Zlift facelift with fat injection to deficient areas. Good luck....

The
definition of facial rejuvenation varies from surgeon to surgeon and means
different things to different patients. In general it is the process to try to
reverse the facial appearance caused by aging. It may involve improving the
skin texture and complexion, diminishing skin discoloration, minimizing fine
lines and wrinkles, contouring hollows, or tightening loose tissue that has
lost its elasticity.

There are a variety of procedures, both non-surgical and surgical which can be
utilized to achieve these various goals. Fillers, Botox or Dysport, long-lasting micro-fat
grafts, chemical peels, a skin care program, lasers, skin tightening, and
surgical lifts are some of the methods that are used to achieve a cosmetic
improvement. Each has advantages and disadvantages as well as limitations of
what they can achieve. The best technique or combination of procedures depends
on desired outcome, individual anatomy, underlying medical health, and extent
of aging. There is no one approach that is ideal for everyone.
Keep
in mind, that following the exact advice from a surgeon on this or any other
website who proposes to tell you what to do without seeing photos and more importantly without examining you,
physically feeling the tissue, assessing your desired outcome, taking a full
medical history, and discussing the pros and cons of the proposed operative
procedure may 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.

Facial rejuvenation needs to be individualized. What would be an ideal approach
for one patient is not necessarily the same for someone else. Based on the
examination and discussion at the consultation, you should have a better
understanding of the various options that can achieve the best cosmetic result
for you.

Robert Singer, MD FACS

La Jolla, California

The key is your objective and what is your anatomy. If you want to make your face look wider-add volume. If there is lax skin , then repostion the skin and maybe the fat too.You might be a candidate for a midfacelift which can be done under local, gets good results and has a weekend recovery.The beauty of this procedure is that it tightens the underlying tissue as well as the skin. It can last many,many years.Good luck from a displaced michigander that ended up in New York.

In our practice, we do not perform a mid face lift, rather we insert small cheek implants over the maxilla to give replacement of loss volume by augmenting the cheeks. Fillers offer a temporary improvement, while cheek implants offer a permanent solution. Cheek implants are manufactured in a variety of sizes and shapes, and are inserted or intra-oral approach under a brief general anesthetic. When patient's have loose and inelastic skin in the face and neck, jowls, loose facial and neck muscles and fatty deposits located in the neck, these are indications to perform a lower facelift. For examples of both procedures, please see the video and the link below