I'm in my early 30's. I lost a ton of weight yrs ago and it's taken a long time to get off the yo-yo dieting cycle. Could years of weight loss/weight gain have caused my face to sag? My cheeks have been kind of flat since I was a child, though in these past years, I've taken on a more long facial shape, saggier in the lower face (square), flat mid face, under eye hollows..lines, folds etc. Any procedures to give me some lift? Already tried fillers. Thank you!
Flat Cheeks, Drawn Face, Feel Like I'm Frowning All the Time (I'm Not) - What to Do?
Doctor Answers (7)
Cheek implants are best option for flat cheeks
Fillers are of limited value for augmenting facial volume in the cheek area. The best option for flat saggy cheeks is to perform augmentation with cheek implants. These implants available in many different shapes and sizes. The best implants are made of silastic. They come in malar and submalar varieties and sizes range from small to medium and extra large. The implants are an excellent way to volumetrically enlarge the flat saggy cheeks areas. They are placed usually under general anesthesia and are inserted through an incision underneath the upper gumline and placed directly over the bone. Sutures that are used are dissolvable. Visible swelling takes approximately two weeks to subside and full healing is usually two to three months after the procedure has been performed. They are totally reversible and can be removed or replaced with a different size in the future.
Loss of skin elasticity and faical laxity
There is no doubt that yo yo dieting can be associated with skin laxity and loss of facial fullness. Fat grafting as well as fillers are reasonable approaches to this problem with alloplastic implants being another alternative.
Cheek implants correct flat cheeks.
If, besides small cheeks, the skin is sagging then you need both cheek implants and a cheek lift. This should be done by a very experienced surgeon so that the eyelid is not pulled down.
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Although you do not include lateral or oblique views, you describe, and appear like, a hypoplasia of the midface and malar region (i.e, sunken in midface). If you look better when you are actually smiling, which I suspect you do, then some sort of a cheek implant with a midface lift would be helpful. You should choose your surgeon carefully as this is not a common procedure and it can be over- or under-done.
Flat cheeks treatment
I do not see jowling in the photo so it is unlikely you would benefit from any type of surgical lift procedure. You do not say why type of filler was tried in the past, where it was placed or how much was injected. All are important points. I think your best bet is fat grafting or sculptra injection into the cheek area. That will make a significant yet natural looking difference if done properly. I cannot tell from this photo if cheek plants are warranted/would help.
Cheek implants are the best answer
From your description and the photo , I would strongly suggest you consider malar shell or combined malar/submalar shell implants would solve most of your problem . They are permanent yet reversible as they can be removed or replaced. See someone experienced with the procedure that is used to insert these.
Fat transfer or other Injectables can work but I think it is less predictable and less likely to give the desired shape of fuller cheek bones. This may be especially true in your case since you have appeared flat in the cheeks all your life. Your problem is both skeletal and soft tissue.
Restoration and Rejuvenation of the Gaunt, Drawn Minimally Sagging Face
Regarding: "I'm in my early 30's. I lost a ton of weight yrs ago and it's taken a long time to get off the yo-yo dieting cycle. Could years of weight loss/weight gain have caused my face to sag? My cheeks have been kind of flat since I was a child, though in these past years, I've taken on a more long facial shape, saggier in the lower face (square), flat mid face, under eye hollows..lines, folds etc. Any procedures to give me some lift? Already tried fillers. Thank you!"
You have an EXTREMELY attractive face which you have misdiagnosed and obviously under-treated by your former physician(s).
Due to extensive fat loss and deflation of the face, your beautiful high cheek bones are also associated with pronounced Tear Troughs.
There is loss of fat in the Mid-Face leading to some sagging and minimal Nasolabial (nose to corners of mouth folds).
The most dramatic feature of loss of fat in the areas under the cheek bones giving you an anorexic / sickish dimpled look which is very aging.
Judicious fat grafting of all of these areas will GREATLY restore your face to a youthful look.
Dr. Peter Aldea