No Holds Barred: Scalpels and Sutures
Concern: Forehead Lines and Falling Brows
Botox is your best bet for smoothing forehead lines, but surgery is necessary to reposition a drooping brow. A browlift can be performed one of three ways (see our glossary); all of the procedures require anesthesia. Downtime is about five days; bruising and swelling may not completely subside for several weeks.
Cost: $400 for Botox; $3,000 for browlift.
Concern: Crow's Feet
One treatment with a fractional ablative laser can dramatically smooth deep lines around the eyes. The procedure requires pain medication, and you'll have red, flaky, swollen skin for several days afterward. The nonablative version of the fractional technology involves only mild redness and swelling but requires three to five treatments (at 30- to 60-day intervals), and won't completely efface deep lines. (Both lasers can also be used all over the face.)
Cost: $1,500 for fractional ablative laser; $1,000 for fractional nonablative laser (per treatment).
Concern: Droopy Lids and Hollows Under the Eyes
Eyelid surgery (blepharoplasty) removes excess sagging skin above and below your eyes, and in many cases the undereye fat pads can be repositioned to plump up hollows in your tear troughs. If that's not possible, some surgeons also inject fat (harvested from the patient's thighs or buttocks) under the eyes. Blepharoplasty calls for anesthesia; downtime is about four or five days (with potential bruising and swelling for weeks).
Cost: $3,000 for blepharoplasty; $1,500 for fat transfer.
Concern: Deep Lines, Sagging Cheeks, Loose Jawline
A facelift can smooth deep lines and add fullness to the cheeks by repositioning sagging fat pads and tightening underlying tissue. The surgery may also minimize hollowness under the eyes. Many surgeons now perform "short scar" facelifts, cutting from the temples (behind the hairline) down in front of the ears, stopping just behind the earlobes. If you also want to tighten your jawline, the incisions can continue up into your hairline behind your ears; the surgeon will reposition underlying tissue and remove excess skin in the lower face. The procedure is performed under anesthesia; downtime is a week or two, and bruising can last over a month.
For more details, read our skin treatment dictionary
Our Expert Panel
Lisa Airan, MD, aesthetic dermatologist in New York City
Trevor Born, MD, clinical lecturer of cosmetic surgery at the University of Toronto
Charles Boyd, MD, assistant clinical professor of otolaryngology at the University of Michigan Medical School
Fredric Brandt, MD, director of the Dermatology Research Institute, Coral Gables, Florida
Anne Chapas, MD, clinical assistant professor of dermatology at New York University Medical Center
David Colbert, MD, director of New York Dermatology Group
Jeffrey Dover, MD, associate clinical professor of dermatology at Yale School of Medicine
Haideh Hirmand, MD, clinical assistant professor of surgery at Cornell-Weill Medical College/New York Presbyterian Hospital
Ranella Hirsch, MD, assistant clinical professor of dermatology at Boston University Medical Center
Stanley Jacobs, MD, Founder of the Center for Facial Cosmetic Surgery, Healdsburg, California
Arielle Kauvar, MD, clinical associate professor of dermatology at NYU School of Medicine
Alan Matarasso, MD, clinical professor of surgery at the Albert Einstein College of Medicine of Yeshiva University
Your Guide to Perfect Skin