Considering a facelift? What should you check first?

Before deciding on a facelift, start by checking how much you've actually sagged. The plan depends on how much loose skin there is, whether it's sagging or hollowing, and whether it extends into your neck. If there's enough excess skin that it would need to be removed, a surgical consultation is the right fit; if sagging is mild to moderate, you can start with a thread lift consultation.

Five ways to gauge sagging

Feeling like you've “sagged a lot” in the mirror often doesn't match the actual state of your tissue. In the consultation room, these five points are checked in turn.

• Amount of excess skin: When the cheek is gently lifted toward the ear, does leftover skin fold like a wrinkle? The more excess skin there is, the harder it is to address by lifting alone.
• Sagging vs. hollowing: Has the cheek moved down, or does it look sunken because volume has decreased? If hollowing is the main concern, filling is discussed before lifting.
• Where it sags: Which area has dropped the most: the cheek below the cheekbone, the jowls along the jawline, around the mouth, or the neck? Whether it's one area or several also matters.
• Neck condition: Is the neck skin loose, and do vertical bands stand out clearly when you lift your chin?
• Skin thickness and firmness: Is the skin thin, and has it lost much of its firmness? Even with the same degree of sagging, skin condition changes the plan.

Doctors sometimes grade jawline sagging or marionette lines on a five-point photo scale. Rather than judging on your own, it's more accurate to be examined from the front, in profile and with expressions.

(Evidence: lower-face aging scale study, 2012)

When a surgical consultation is the right fit

To be honest, if any of the following apply, it makes sense to see a plastic surgeon for a surgical consultation first.

• There's so much excess skin that it seems it would need to be removed
• Your neck skin is loose and vertical neck bands are prominent
• Your cheeks, jawline and neck have all dropped significantly at once
• You want a long-lasting change from a single surgery

Removing excess skin and re-securing the deeper layers can only be done surgically. The American Society of Plastic Surgeons makes this clear as well.

(Evidence: American Society of Plastic Surgeons, facelift information)

What a thread lift consultation can cover

On the other hand, in situations like these, you can start with a thread lift consultation.

• Sagging is mild to moderate and there isn't much excess skin
• Your cheeks or jowls have dropped and make your lower face look wider
• Along with sagging, your cheekbones and cheeks look like they carry too much volume
• You have a mix of sagging and hollowing and want to plan lifting and filling separately
• You can't take much time off and need a short recovery

A recent review of dissolvable thread lifts also concluded that “in well-selected patients,” changes appear right after treatment and the risk of serious complications is low. It also noted that long-term data on results is still limited. How long results last and how much change you see vary from person to person.

(Evidence: review of 12 studies and 818 patients, 2025)

What to sort out before your consultation

• The one or two areas that bother you most
• How much change you want (a subtle refresh / a noticeable change)
• How much downtime you can take and any important dates
• Previous treatments and surgeries, and any medications you take

Your face in photos and the state of your tissue on examination can differ. Some people worry about heavy sagging when hollowing is actually the bigger issue, and vice versa.

With these four things in hand, your consultation can quickly sort out whether a surgical consultation fits or a thread lift plan is worth considering.