To facelift or not to facelift… that is the question! (Apology to William Shakespeare)

Hello! I'm a 48 year old woman and it seems that my face is going south! I am a former smoker of 20 years, It's been 7 years since I touched one of those nasty things! I am definitely paying the price now. I've got lots of things going on with my face that I am just not happy with: sagging eyelids, marionette lines, fine lines above my lip, small jowls are forming and my neck skin is awful! I am considering some fillers and botox (I've had botox before and loved it). I have had two consultations with different med spas, and I have one scheduled later this week for another local (non chain med spa) as I figure they deal with injectables a lot so they would have some suggestions. One thinks filling my chin and the space between my chin and the jowl would help, the other is suggesting a cheek fill to lift the face and restore lost volume. I am leaning towards the cheek fill as I think my once chubby cheeks seem to have slid down to my jawline! I would also be getting botox for the crows feet and forehead and possibly a peel to help with the fine lines around my mouth. I have two questions... first: what is better cheek or chin fill for mild jowls? And second: can I do all at the same time?

I love that you wrote this because it touches on an issue many of us think about. Is there a time when a facelift makes more sense than nonsurgical options? You all know me, I’ve written two books on this; “Your Best Face: Looking Your Best Without Plastic Surgery” and “The Surgery-Free Makeover”). Alternatives to surgery just keeping improving every year! I’m a big fan of nonsurgical options. Having said that, for each individual there is a cost benefit analysis to be done. Sometimes, it makes more sense to have a facelift! Why? Because for the same time and money you might be able to accomplish more of your goals. This assuming a good surgeon. It’s a very individual equation. Without seeing your individual face, it’s impossible to know whether filling the cheek or jawline area would be best. 🙂

What plastic surgery can do:

  • It can take care of the jowls, under chin area (submental), and pull up/tighten neck skin all at the time.
  • It can reposition the cheek, if a mid cheek lift is done.
  • Most surgeons are happy to do the sagging upper eyelid at the same time (an upper lid blepharoplasty).

What plastic surgery doesn’t do:

  • It doesn’t improve the quality of the skin. If your damage is from sun and/or smoking you need great skincare, lasers, and sun avoidance to fix that.
  • It doesn’t improve many of the wrinkles, texture problems due to large pores, or acne scars. Lasers or injectables do a better job.
  • Flushing, baseline redness, dilated blood vessels, and brown spots don’t improve. These do better with lasers.
  • The upper lips lines.

A couple of other thoughts: plastic surgeons will often offer to do a peel or laser at the same time as the surgery. In our experience, the results from this are not usually good, and just add to the potential for complications. Some plastic surgeons will want to do fat transplantation at the same time as the surgery. This is really technique dependent. We’ve seen some great results from surgeons and a some quite awful ones. Fat transplantation gone wrong is very difficult to undo or correct.

Hope this helps,
Dr. Brandith Irwin
Founder, SkinTour
Director, Madison Skin & Laser Center
Follow my skin tips and travels on Instagram!





Dr. Brandith Irwin, MD

Ask me your skincare question!

Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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