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

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!

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.