Glenn Vallecillos, MD, FACS

Yes, abdominal etching can be performed on postmenopausal women. However, it is important to note that individual medical conditions and the presence of underlying health issues should be taken into consideration before undergoing any cosmetic procedure. It is recommended to consult with a qualified plastic surgeon who can assess your specific case and advise on whether abdominal etching is appropriate for you.

1. Filler that got dissolved: If you had filler and got it dissolved, it is very important that you got all of that filler dissolved completely. If you had already had more than one session (of dissolving) it may be prudent to get an MRI to determine if any of the filler is still present or if there is another concern. 2. Not a great candidate for surgery: Are you "not a great candidate for surgery" due to an underlying medical condition? If you are "not a great candidate for surgery" due to reasons that could be treated; please begin to make those changes for the betterment of your health and quality of life; I'm recommending that you make those changes because surgery would be the only option that would completely remedy the "malar festoons" that you've developed. 3. Options: Non-invasive options: Getting treated with a Radio Frequency Assisted Laser (RFAL) would improve the lines to a certain degree. I would recommend fillers, but considering your recent dissolving, it seems best avoided. I recommend (if you're not already) to begin using sunscreen in the morning (or before you go-out) and avoid substances that age you such as smoking, drinking, and sugars (fruit and natural sugars are fine to a certain extent) as much as possible. It's essential that you begin checking ingredients when shopping for sunscreens and for your food/beverages. Sadly due to lack of regulation in America (unlike other countries) we have many aging, disease causing, toxins and hazardous chemicals and "ingredients" in our food, household products, on our clothes, and nearly every other product. Please research and make the best choices for your own health.

The cause of your mid-face and jowl sagging is due to the loss of facial volume that used to hold your skin in its previous "taut" fashion. As we age we lose skeletal, fat, and muscle volume in our face The reason for my header being "The best long-term result would actually be invasive: Facial Fat Transfer combined with RF lasers" is because facial fat transfer WILL be more cost-effective in the long term and it's more natural because it's your own fat; compared with fillers. If you decide to not go down the facial fat transfer route, fillers will be your next best thing. Regardless of what route you choose; you will need to "fill" the mid-face hollowness first AND THEN tackle skin tightening. If you don't have a skin-care routine it's essential that you begin one. Having a tried and true skin care routine will increase the quality (tightness, look and feel, texture, tone, moisture, and smoothness) of your skin and the higher quality of your skin the better the results of nearly EVERY aesthetic treatment you get and the better you'll heal for anything invasive. If you're absolutely set on the " best least invasive procedures" for the results you desire I'd recommend sticking to injectables and RFAL lasers.

The order of operations you should take to address your lower face sagging is above. But let me expand below: *NOTE* You're very young and because of that you should only consider more invasive treatments and invasive treatments (Steps 3 & 4) once you're older and actually need them. At your age aesthetics is generally more about prevention than anything else. 1. Skin Care and Diet: Getting a complete and legitimate skin care regiment (making sure ingredients and effectiveness is at a quality level that you're comfortable with and desire) is very important for how your skin will age (gracefully like wine or stinky like cheese). Diet will literally make or break your mood, skin quality, results, and so much more. You truly are what you eat. I recommend noting how certain foods make you feel and staying away from anything that causes inflammation (or at least only consume those foods sparringly) such as fried food, processed foods, any sugar that's not from fruit, and if applicable, any foods that cause inflammatory responses for you personally. If you get both skin-care and diet on point, you are already ahead of majority of people on earth in terms of self-care. 2. Non-Invasive: Radio Frequency Assisted Lasers (RFAL) & Micro needling will be able to give you better skin texture and tone while tightening your skin. In our office, we would use Morpheus8 to tighten your skin and Fraxel or Clear & Brilliant to address skin clarity and texture while treating un-seen sun damage. Micro-needling works wonders for building collagen and the overall texture of your skin; smoothing out your skin tone. 3. More invasive treatments The next degree to consider would be something more invasive such as FaceTite, Threads, and Renuvion JPlasma, all of these methods will tighten your face from deep layers within your skin. 4. Invasive Treatments It is not worth expanding on this because you're simply too young and do not require invasive treatment. Something that you might want to put on your radar for the future is "buccal fat removal", as removing those fat pads will create a "slimmer" and "tighter" looking face that takes off the "rounding" of those who get the procedure done.

REMEMBER: Always take your time deciding on who will be your provider and on what treatment you end up getting. That means talking extensively with potential providers and getting consultations until you feel completely safe and secure with your final decision. From the photos it seems like you take good care of your skin. Having a legitimate skincare routine is step no.1 when considering any aesthetic treatment; invasive or non-invasive. When it comes to your concerns of "my sagging cheeks, nasolabial folds, and beginning marionette lines" and achieving a "tighter and more lifted look": Buccal fat removal would make your face less rounded and give it that "pulled" look you're going for. But the best results would be achieved with buccal fat removal in conjunction with RFAL's such as Fraxel (for skin quality and texture) and Morpheus 8 (for skin tightness and tone). If you're really serious, you may also want to consider FaceTite and Renuvion J Plasma on your face, because this will drastically tighten your skin from the inner-layers of the skin, but it's not as common for practices to have as Fraxel and Morpheus 8. Fraxel and Morpheus 8 are much more less invasive than Renuvion J Plasma and FaceTite. Filler and botox is an option for a lift effect but this will only be achieved with an experienced injector who was able to produce your desired results before (it's essential that you see as many before and afters as possible if you decide to take this route).

Anytime there is fat transfer loss of the fat is guaranteed, it's a matter of prevention (to keep the fat and the results) and means for it will very depending upon the placement of your fat transfer. Who's right will ultimately be up to you and how you determine that is also up to you; but I urge you to choose the safest option as the "right" option. If safety is your priority, please consider no doing filler anywhere near your silicone implant. I recommend looking up cases to get a general sense for complications regarding injections near or onto a silicone implant, if you do decide to go-through with filler a-top your implant it's best make that decision as educated as possible.

2 Weeks would be an appropriate amount of time to wait for the filler to fully "set" and make sure that your results are in-place and not vulnerable to slight pressures/manipulations (that a VR headset would induce once fashioned - even comfortably on your head. If you want to be very safe wait 3-4 weeks before using your VR headset. You will results will be fine.

The probability of a complication occurring a month after treatment is as close to impossible; as possible. Nearly all complications will occur immediately and those that don't will be identifiable within the same day as your treatment. Blindness, necrosis, and all other vascular occlusion-induced complications are the most scary of all. All of the vascular occlusion complications will be identifiable within the same day of treatment. The sooner any complication is treated, the better the recovery will be. "In addition, can blindness be caused by compression of an artery?" Yes. If you stop blood flow to the eye or the visual center of brain; blindness will result. You will want to ask your injector about safety and blindness prevention specifically; ask them what are the most dangerous places to inject related to blindness and then ask them for as many before and afters of those places as you can see.

An experienced injector may be able to help you achieve a "more symmetrical" look but as with all botox results; it will be a matter of time before it wears off. It's HUMAN to have a face that's unsymmetrical and if you chase that as a goal (perfection) you will begin to not look like yourself - sooner than later. I recommend researching surgical options because they are what's permanent. Also do research on "mewing" and how facial posture and the structure of one's mouth has inverse effects on the make-up of their entire face. For your nose, you have the semi-permanent option of a "Liquid Rhinoplasty" - nose filler. The nose is one of the most complicated areas to inject; for your own safety be sure your injector has tons of experience and tons of before and afters for you to go through. Ideally you'd want to find one or more (the more the better) before and afters of the injector "correcting" similar (the more similar the better) looks and achieving similar results as the one you desire.

The tear-trough/under-eye is a complicated area for injections. It would be in your best interest to discuss potential complications with your injector and make sure to see as many before and afters as possible. It's essential that your injector is well-versed in that section of "injection anatomy"; the nose and under-eyes are two of the most risky parts of the face to get injections (unless it's from someone who does them all the time; or has tons of experience doing so).