What is causing this horizontal dent? Is a facelift my only option? (Photo)

Question

I have lots of volume loss that has caused deep nasolabial folds and now marionette line:( what is really bothering me is the horizontal indent that has formed in addition to the dimple. What in the world is happening?? I've had some filler and it's helped sine but my skin is so loose that it just sags. Is a facelift my only option?? I turn 50 in September. Thanks!

Alan Gonzalez, MD, FACS · Answer

Greetings @laours, thank you for your question and for showing your photos. A mini facelift can help lift and tighten sagging skin on the face, usually focusing on the lower half of the face and neck. Although mini facelifts are often used to correct signs of aging such as jowls, wrinkles and sagging skin, they are not usually recommended if the skin has a youthful appearance. If you do not wish to undergo a surgical procedure, it is quite possible to improve skin elasticity and define the edges of the face or jawline with a non-surgical treatment such as Ultherapy or Morpheus 8. It is important to consult with a board certified plastic surgeon(s) for more information and recommendations. Best regards.

Alan Gonzalez MD, FACS. Member of the International Federation for Adipose Therapeutics and Science (IFATS), Member of the American Society of Plastic Surgery (ASPS), Member of the Colombian Society of Plastic Surgery (SCCP).

Alan Gonzalez MD, FACS. Member of the International Federation for Adipose Therapeutics and Science (IFATS), Member of the American Society of Plastic Surgery (ASPS), Member of the Colombian Society of Plastic Surgery (SCCP).

John Michael Thomassen, MD · Answer

A facelift would be a good way to correct this.  More fillers will just change your facial contour without significantly improving these lines.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

Isolated areas of dimpling in the skin can be frequently addressed using subscision which involves releasing the tethering under the dermis with a needle and allowing the skin to redraping with less tension.

It is possible however that when this is corrected you may still feel that the face to procedure is what you would prefer but if you are unsure about the facelift you can start with the subscision and then decide.

Pasha Mostofi, MD, DMD · Answer

Hi There, 
This is a good question. Two important changes that happen with age are skin laxity and volume loss. With the increase in filler use, unfortunately, the amount or degree of volume loss with age has been over emphasized compared to skin laxity. While volume loss is an important change that occurs with age, skin laxity is much more significant contributing factor for most people. The smile lines and marionette lines that form with aging are much more impacted by skin laxity than they are by volume loss. I think its appropriate to have someone evaluate you for a facelift as I think you might find it is a better solution to address the needs that you've brought up. Hope this helps!

Yasin Kursad Varsak, MD · Answer

Age 50 is actually a very good age for facelift surgery. Facial aging signs typically start to show in one's mid-30s to 40s. While fillers can be a good method to camouflage the appearance of these signs at this age range, they may become inadequate in later years because facial aging results not only from volume loss but also from sagging tissues. In cases where facelift surgery is needed, relying solely on fillers can lead to unnatural results. Based on examining your photograph, I believe you would benefit from a procedure such as an extended deep plane facelift, which addresses the midface and neck areas effectively, along with accompanying facial fat transfer. This also gives you more natural result.

Gary M. Horndeski, MD · Answer

You should consider a lip lift. A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This may significantly elevate your corners enough to correct the indent deformity you dislike.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

I’m not exactly sure what you are referring to. I do think you are a good candidate fir a facelift although you could try fillers first

Jacob Tower, MD · Answer

Hello, hope you are well. Thank you for submitting your question and photos! The information and views of you face are somewhat limited, but there appears to be sufficient skin laxity to consider a facelift. Very careful fat grafting around the mouth may also be considered alongside this procedure. The best thing to do is to have in-person surgical consultations to get a better sense of what can be accomplished with surgery and repositioning the soft tissues of the lower face. Good luck!
Best,Dr. Tower

Amer Nassar, MD · Answer

The typical aging face, involves deflation of fat compartments as well as 'sagging' of skin and the underlying muscular layer called the SMAS. A facelift works to re-suspend these layers back to their original position and in certain circumstances, replenish these fat compartments such as with facial fat grafting.In general fine lines and wrinkles aren't greatly treated with facelifts especially when around the lips, but larger wrinkles and jowling is treated excellently with a well performed facelift.
Kind Regards,
Amer Nassar, MDPlastic and Reconstructive Surgeon

Mats Hagstrom, MD (license on probation) · Answer

Jamaica quality assessment we need quality pictures.
Is there a reason you only included a picture of the left side of your face? Is this a one sided problem? If it is then there may be a medical explanation.
If it’s bilateral, then it is most likely simply a related midface volume loss.
For volume loss facelift is not the best treatment.
For volume loss volume restoration is the treatment of choice.
Have you had in person plastic surgery consultations for this? If not, I suggest you schedule several.
Finding the right plastic surgeon is not easy or straightforward.
To do that I suggest having multiple in person consultations.
When things are not straightforward then expect different providers to have different opinions.
This may be one of those times were different providers may offer different and recommendations.
It’s nice to have choices but when different providers tell you different things it’s sometimes also leaves patience, confused and not trusting any one of them.
 During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of the previous patients who had similar facial characteristics to your own for whatever procedure they recommend.
When it comes to fat transfer, which may be a legitimate treatment, and something that is recommended recognized that early fat transfer results can look very impressive, but do not represent final long-term results.
 When reviewing outcomes for this procedure, always confirm that the after pictures were taken at least 3 to 6 months from the date of this procedure.
Never assume and always confirm.
There’s no correct number of consultation needed to find the right plastic surgeon.
The more consultations you schedule the more likely you are to find the better provider for your needs.
 You may want to consider reposting with a complete set of proper facial pictures.
Take a look at how plastic surgeons take before and after pictures to get an idea.
Limited pictures gives us limited information to work with in regards to making an assessment.
Quality assessments, always, from in person, consultations, which I highly recommend in comparison to virtual consultations.
 Best,
Mats Hagstrom, MD

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