The face of the 21st century is forever young. Plump lips, smooth foreheads, thin-lidded eyes and taut necks fill our magazines and television screens. Thanks to advancements in cosmetic aesthetics, a 60-year-old can now look 45 and a 35-year-old can shine like a 20-something. It’s a brave new world of fillers and lasers and mini-lifts, where youth can be bought for a few thousand bucks and hardly any pain or downtime, right?

Wrong.

It’s time to face the facts.

Most professionals readily agree that such non-invasive procedures as Botox, and skin filler injections such as Restylane, have pushed the envelope in the field of aesthetic medicine. But while they may provide a quick fix for some people—primarily those under 45—they’re not the answer for everyone, especially when used in isolation.

By the time we reach 50, most of us have lost skin elasticity in our face and in other areas. Non-invasive techniques won’t solve everything. What it takes is surgery. You know—a good old-fashioned facelift.

"Everyone loves the idea of a minimally invasive procedure," says Dr. David L. Mobley. He’s an American Board of Plastic Surgery-certified plastic surgeon specializing in aesthetic surgery of the face, breasts, and body. “But these aren't always the right choices. In our 30s, we can use injectable fillers, lasers and other tools to correct lines and wrinkles. When we reach 40 and beyond, we may need to turn toward other techniques.”

It comes down to a simple fact, he explains. If you have a lot of skin laxity, you’ll need some type of lift to fix it. “It’s really the only procedure that can remove the sagging skin around the face and neck. A filler alone can’t solve this problem.”

But what about the promises of stitch-free miracle fixes?

“There’s a lot of hype being marketed to the layperson,” says Dr. Robert P. Hillstrom, a facial plastic surgeon certified by the American Board of Facial Plastic and Reconstructive Surgery. “Whether they’re selling the ‘Lifestyle’ or ‘Lunchtime Lift,’ or convincing people that noninvasive procedures will work on every face at every age, we need to educate ourselves about our options. No two faces are the same.

“The ‘Lifestyle Lift,’ for instance, is a variation on a conservative mid-facelift and is being sold as the miracle solution for every face, which is just wrong,” he continues. “In my practice, I offer two approaches to the aging face: the more conservative, mid-facelift, and the traditional full-facelift, the latter of which addresses the brow, neck and face. The mid-lift, as a rule, is more applicable to younger individuals, whereas this is often not enough to address the aging characteristics in the brow and neck that tend to be more noticeable as we get older.”

According Mobley and Hillstrom, here’s what you can expect to face in the mirror over the years.

Let’s skip the happy days of youth. By the time we hit our 30s, our eyes begin to show signs of aging, with crow’s feet and some eyelid bulging—nothing a little Botox and Restylane won’t erase. These are the years to take full advantage of injectable soft tissue fillers to soften wrinkles, folds and scars.

By our mid-40s, our cheeks begin to lose fat and laugh lines become sadly visible. As we push 50, creases open up on either side of our mouth, the jaw line slackens, and the muscles and skin of the neck begin to sag and lose definition. If we take it as a sign of character, great. If not, our best option is probably a combination of fillers, lasers, and a minimal lifting procedure—such as a mid-facelift.

By our mid-50s, gravity has taken its toll. Are you a sun worshipper? Fond of late-night partying? Look in the mirror and you’ll read the story of your life in the lines of your face. (And is it just your imagination, or are you starting to look more and more like Richard Nixon?) Don’t despair—repair is possible, though it’s going to take more work. Saving face, at this point, may involve a creative combination of a full facelift, brow lift, eyelid surgery, fillers and laser resurfacing.

Let’s start with the many varieties of the facelift.

The friendly facelift

“Today’s facelift is much better and safer than the one we did 10 years ago,” says Mobley. “Early facelifts tightened only the skin; now we’re able to remove excess skin and tighten lax facial muscles. We can also improve the skin quality with laser and other peeling techniques during the surgery.”

According to Mobley, the results leave you looking younger and more refreshed without a stretched appearance. Depending on your needs, the facelift can be combined with a forehead or brow lift, eyelid surgery (blepharoplasty), laser resurfacing, fillers and other procedures.