Question: I am 63 and had a facelift at 50. While I have developed some loose skin along my jawline, the hollowing of my cheeks, temples and lower lids makes me look gaunt and skeletal. I saw 2 plastic surgeons both of whom advised a facelift, but how will a lift take care of my upper face hollowing?

Answer: You are smarter than most to recognize that a facelift doesn’t correct volume loss. As we age, we don’t just develop loose skin along the the lower face and neck but we also lose fat and bone in our face. On top of this, we lose collagen and elastin within our skin layer. These losses in our skin, bone and fat layers are not necessarily corrected with facelift surgery. In fact, in the presence of volume loss, a facelift may make you look worse, giving a pulled or windswept appearance.

With age, facial volume loss can happen at 3 different tissue levels. The skin or upper layer loses volume through loss of collagen and elastin, resulting in wrinkles, fine lines and deepening pores. Acne scars and other facial scars can also worsen with age.

The fat or middle layer consists of numerous fat compartments. Since each person’s face is different, we lose fat in a unique pattern. Some have hollow temples with narrowing of the eyes. Others hollow under the eyes and look tired. Additionally, some patients experience loss of fat in the cheek area.

The bone or deepest layer is similar to the spine in that both lose bone with age and remodel to change their shape, resulting in a droopy, narrow appearance to the upper face and eyes. Bone loss along the jawline can worsen sagging jowls. Facial sagging is not simply due to loose skin or collagen loss but also comes from loss of the fat and bone. Facelifts tend to work best on younger patients who don’t have significant volume loss.

With continued aging, facial volumization must be addressed at all three levels to restore a youthful, natural appearance. Restoration of volume loss in the skin can be effectively accomplished with Infini RF combined with skin growth factors. Volume loss due to facial fat and bone can be effectively corrected with long term volumization fillers such as Bellafill, the 5-year filler, due to its cost-effectiveness. Unlike temporary fillers, Bellafill can be used off-label in nearly every area of the face and in multiple depth levels.

Consulting with Board Certified Facial Plastic Surgeon who specializes in minimal invasive facial rejuvenation is the first step. A detailed understanding of facial anatomy, superior technical expertise and an artistic eye are also important considerations.

Anita Mandal, MD

Dr. Anita Mandal is a double Board Certified Facial Plastic Surgeon practicing since 1998. She exclusively specializes in facial rejuvenation and non-invasive body contouring. In addition to being on the medical staff at Jupiter Medical Center, her offices house both surgical and laser suites. Dr. Mandal is committed to giving her patients the most natural looking results. 

Mandal Plastic Surgery Center 

2401 PGA Blvd., Suite 146 

Palm Beach Gardens, FL 33410 

Phone: (561) 238-0040

Website: www.MandalPlasticSurgery.com 

E-mail: [email protected]