This 54 year old patient illustrates many of the features of early facial aging. Her face has become rectangular in frontal view due to the descent of the soft tissues of the cheek and the formation of jowls. She has Marionette lines descending from the corners of the mouth; and the development of prominent neck folds that have led to the loss of the cervico-mental angle (angle between neck and chin). These were addressed by a full facelift. However, the Marionette lines will probably require further improvement by the injection of a filler such as Juvederm.