Ali Riza Öreroglu, MD

Based on what I can observe from your photos, the combination of full cheeks, a round facial shape, and early signs of aging in the lower face (such as jowls, neck laxity, and marionette lines) suggests that a deep plane facelift combined with buccal fat removal (bichectomy) could be an effective and long-lasting solution. The deep plane facelift lifts not only the skin but also the deeper facial structures, providing a more natural and long-term improvement in sagging—especially along the jawline and neck. Bichectomy reduces midface volume by removing buccal fat, creating a more defined and feminine facial contour without relying on fillers, which you understandably prefer to avoid. Additionally, PDO thread treatment can be considered as a less invasive alternative or complementary procedure. PDO threads are biodegradable sutures placed under the skin that create a lifting effect and stimulate collagen production, helping to tighten and rejuvenate the skin. This method can be effective for early signs of aging and mild sagging, with a shorter recovery time compared to surgery. However, a physical examination is crucial to more accurately assess your facial anatomy, skin quality, and soft tissue dynamics. This will help determine the most suitable personalized treatment plan for you.

Your age, 28, is not a limiting factor for a facelift, as facial changes depend less on age and more on factors like gravity, genetics, and your skin’s natural characteristics. Some people may experience early signs of sagging or asymmetry regardless of age. For your concern about a weak chin and early sagging, submental liposuction (under-chin fat removal) combined with jawline contouring can help create a more defined and natural-looking lower face and profile. This procedure enhances the jawline, giving your face a stronger and more balanced appearance. If you feel your face looks wider or more square due to prominent masseter muscles (the chewing muscles at the jaw angle), Botox injections to the masseter muscle can slim the lower face and soften your jawline. To address facial asymmetry, dermal fillers can provide temporary improvement, but for a more natural and longer-lasting result, fat grafting (fat injections) is recommended. This technique adds volume using your own fat, improving both symmetry and skin quality. Overall, a combination of these treatments may offer the best outcome to enhance your facial symmetry and profile. However, a physical examination is essential to create a personalized treatment plan that suits your unique facial anatomy and aesthetic goals.

If there is noticeable skin laxity, a lower facelift can help restore a more defined and lifted jawline by repositioning the underlying tissues and removing excess skin. When combined with a neck lift, this can further enhance the contour of the lower face and neck for a more youthful and feminine look. Additionally, one common factor contributing to a wider, more squared facial appearance is hypertrophy of the masseter muscles (the chewing muscles along the jaw). If these muscles are prominent, Botox injections can be used to soften and slim the lower face by reducing muscle activity over time, leading to a more tapered and elegant jawline. However, to determine the most appropriate and effective treatment plan for your individual anatomy, an in-person physical examination is essential. This allows for a thorough assessment of your facial structure, skin elasticity, tissue tone, and any residual fat or asymmetry.

If you're 34 and feel that you appear older than your age, and you're aiming for a more age-appropriate look, a deep plane facelift could be a great option for you. This technique effectively addresses early signs of sagging and volume loss in a natural way. The deep plane facelift targets the deeper layers of tissue, reshaping your facial contours and providing a youthful, natural result without creating an artificial look. It’s ideal for achieving a more age-appropriate appearance without overdoing it. Additionally, fat injection (fat grafting) can be a great complement to the facelift. It helps restore volume to areas where you’ve lost fullness, such as the cheeks, under the eyes, or along the jawline, giving you a more youthful and balanced look. And lower blepharoplasty can also contribute to your rejuvenation. However, the best approach would be to conduct a physical examination to assess your facial structure and skin quality. This will allow us to determine the most suitable treatment plan tailored to your individual needs.

Given that you're 46 and experiencing skin laxity and descent in the mid and lower face, my recommendation would be a deep plane facelift. This technique is deeper than traditional facelifts and targets the underlying facial structures, providing more natural and long-lasting results. It will help correct the downward movement of your cheeks and restore a more youthful appearance. Additionally, for the tired look around your eyes, I would suggest lower blepharoplasty. This procedure removes excess skin and fat under the eyes, giving a more refreshed and rejuvenated look. Both procedures aim to address volume loss and skin laxity, helping you achieve a more youthful and rested appearance. A physical examination and detailed consultation would be necessary to create a tailored plan for the best possible outcome. I would also recomment facial fat grafitng to restore some volume and correct proportions