It’s a top area of concern for many people as they age — sagging skin, jowls, turkey neck. While non-surgical treatments, like fillers, lasers and so forth, can help give skin a boost, there might come a time when a person wonders, “Is it time for a facelift?”

And how do you make that call?

“I have seen 50-year-old patients who need full facelifts, yet others of similar age who only required non-surgical intervention, like Botox and fillers,” said Dr. Kevin Sadati, a facial plastic surgeon in Newport Beach, California.

“All faces age differently, so there really is not a perfect answer for this question.”

First, and doctors agree, it’s totally a personal decision. You don’t need to do anything if you don’t feel like it.

But, as Tamra Judge from Real Housewives of Orange County said, if you’re ready to “pull it, don’t plump it,” here are some tips to exploring options. As always, only an in-person consult with a highly qualified plastic surgeon can help you determine the right options for you.


Fillers only do so much


Doctors on RealSelf told us the top sign that it might be time for a facelift is a lot of sagging skin.

“The one thing that can’t be done with non-surgical treatments is getting rid of excess skin,” said Dr. Anthony Youn, a Detroit plastic surgeon. “When the skin is wrinkled or slightly loose, then non-surgical treatments can be helpful. But when there is excess, sagging skin, then non-surgical treatments just won’t cut it.”

Dr. William Portuese, a Seattle facial plastic surgeon, agrees.

The signs we look for in the aging face for our patients [are when they] start to develop jowls and neck laxity,” he said. “Fillers work quite well to augment and add volume to the face, but it is important understand that they don’t lift tissues. Patients are told often that they can get a lift from placement of temporary fillers. A facelift lifts tissues.”

Whether a patient opts for a facelift, a lower facelift or a neck lift, these procedures will remove loose facial or neck skin, tighten underlying muscles, and remove fatty deposits.

Dr. Portuese also said that one of the toughest areas to treat non-surgically is the neck, one of the first areas to show aging. If you are showing advance signs of aging in this area, talking to your surgeon about a lower facelift or neck lift might be a viable option.


Related: Facelift guide: frequently asked questions.


Treatments that can bridge the gap


The good news is that as technology improves, we’ll see more minimally invasive treatments that work.

One treatment that might be a bridge from non-surgical fillers to facelift is FaceTite. Plastic surgeons are already excited by the results they’re seeing in this facial rejuvenation treatment that tightens skin, stimulates collagen, and melts a small amount of fat.

Dr. Brent Moelleken, a Beverly Hills plastic surgeon, told us that he’s been using FaceTite, which uses radiofrequency, for about six months and has done about 30 procedures. He says some people see immediate results, but it often takes up to six months for full results.

“[It’s for] patients who are borderline for a facelift or mini-lift, but don’t want to have surgery,” said Dr. Moelleken. “Also patients with a double chin who want precision liposuction. I like it a lot. It bridges the gap between completely non-surgical and surgical options for patients.”



Dr. Sadati said that he’s seeing good results with Vivace, a non-surgical contouring and skin-tightening procedure that combines microneedling with radiofrequency. He sometimes adds a PRP option to optimize skin rejuvenation.

“[It] can help patients who are either not quite ready for a face or neck lift, or who have had a facelift previously and desire a little skin tightening but don’t require surgery,” he said.

Whatever you decide, make sure you schedule at least three consults with different doctors to get the best options for you.