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At 32 years of age, my general recommendation would focus on structural balance and minimally invasive options, rather than surgical procedures.
First, I would evaluate for volume loss in the preauricular area (the region just in front of the ear) and in the temples. These areas often lose volume earlier than patients realize, and when that happens the cheekbone can appear wider or more prominent than it actually is. Strategic filler placement in these areas does not widen the face. In fact, it often creates a smoother transition and can make the face appear more balanced and naturally contoured.
A simple way to assess this is to look in the mirror and see whether there is a visible hollow in front of the ear below the cheekbone or in the temple area. If those areas appear hollow, restoring volume there can significantly improve overall facial harmony. I perform this type of structural balancing frequently and have seen very good results.
Second, if your goal is a more defined or “snatched” look with improved midface support and contour, threads can be a good option in appropriately selected patients. Threads are designed specifically to reposition soft tissue and improve contour without surgery.
Third, I would generally advise caution with surgical options such as a facelift at age 32. Facelifts are excellent procedures when performed at the right stage of aging, but they typically provide results that last about 7–10 years. If someone were to start undergoing surgical facelifts very early, it could lead to the need for multiple surgeries over a lifetime, which is usually not the best long-term strategy.
For that reason, most patients in their early 30s are better served with less invasive treatments that maintain structure and delay the need for surgery.
Finally, regarding energy-based skin tightening treatments such as ultrasound or radiofrequency devices, my personal experience has been that the results are often modest and somewhat unpredictable. Some practitioners report good outcomes, but overall I have found the improvements to be relatively limited compared with structural treatments like filler or threads.
A consultation with a physician experienced in facial structural analysis can help determine the best combination of treatments for your anatomy and goals.

I’m a lean-ish 32 year old, and I’ve had a heavy lower face my whole life. Recently, I’ve noticed significant hollowing in submalar area and the lower face fat sagging forward. I have a naturally short chin and was considering filler to lift this area. However, when I lift the skin/fat back with my finger, it’s exactly the look I want. Do PDO threads last? Or is a facelift my only hope? Grateful for any insight.

Lower face sagging bothering me - will a PDO thread lift help or do I need a facelift? (Photos)

Your description of a localized contour change in the cheekbone area several years after a PDO thread lift is something I have not see before after placing more than 4000 threads. Without examining you in person or knowing the exact thread depth and vector placement, it is difficult to determine the exact cause with certainty, but a few possibilities should be considered.
First, the changes you describe if related to thread-induced fibrosis or tethering, could be if the threads were placed too superficially. Even though PDO threads dissolve within months, they stimulate collagen and fibrotic support in the tissue. In some individuals, that fibrotic response can persist for years and may create band-like or contour irregularities, especially when smiling.
Second, individual biology can influence how the tissue reacts. Patients with autoimmune conditions, inflammatory tendencies, or hypersensitivity reactions can occasionally develop more pronounced fibrosis after procedures that stimulate collagen. A somewhat similar phenomenon is occasionally seen with other collagen-stimulating treatments such as PLLA (Sculptra).
When I look at cases like this, I also evaluate the overall facial balance, not just the focal area. In many patients who feel that their cheekbone looks “too wide,” there is actually volume loss in surrounding areas that makes the cheekbone appear more prominent.
In your description, I would also consider two areas that commonly contribute to this perception: • Temple volume loss • Preauricular volume loss (the area just in front of the ear)
Strategic restoration of volume in these areas does not widen the face. In fact, when done correctly, it often makes the face appear more balanced and narrower, because the cheekbone transitions more smoothly into the surrounding structures. Instead of adding bulk to the cheekbone itself, the goal would be structural harmony and smoother contour transitions.
Because of this, I typically recommend addressing surrounding volume balance before considering more aggressive interventions such as: • Subcision or fibrotic release • Surgical revision • Scar-modifying procedures
In many cases, careful structural correction can significantly improve the appearance of contour irregularities without needing invasive treatment.
That said, if the irregularity truly represents localized fibrotic tethering, treatments such as targeted release techniques or surgical revision can sometimes be considered, but these are usually reserved for cases that do not respond to more conservative approaches.
An in-person evaluation with a physician experienced in thread lifting and facial structural analysis would be the best way to determine the exact cause and appropriate treatment plan.

I had a PDO thread lift about 5 years ago in the cheek/cheekbone area for lifting the midface and nasolabial folds (likely Soft Lift PDO, barbed or Arte). Since then I’ve had a persistent localized contour change: • A raised/widened area over the cheekbone, more noticeable when smiling • Tissue feels mostly soft but with string-like / band-like tissue deeper • Hyaluronidase had no effect, so this does not appear to be filler. My main concern is excess volume/widening. I am not interested in fillers or camouflage — my goal is to reduce the volume and return the cheekbone area as close as possible to its natural shape and width Questions: * Does this presentation sound more consistent with thread-induced fibrosis/tethering rather than a retained PDO thread? * Can mature fibrosis (5 years old) from PDO threads still be treated or improved? * What treatments, if any, are used to reduce this type of excess volume (e.g. subcision/release, injections, surgical revision)?

Revision options for cheek fibrosis/tethering after PDO thread lift? (Photos)

The simple answer to your question is yes. How much symmetry will you achieve that is dependent on a product placement and the type of product used I generally use Voluma for this area, but there are other products that work really well as well.

I have always had a divet in my chin on the left due to a misaligned jaw but as I get older, it’s more noticeable. Can dermal fillers be used to create symmetry in the jaw/chin area? I constantly look like I’m holding food in my mouth on the left side. I’m desperate to fix this as it’s very noticeable. I know there are long term solutions to fixing this, but I run a client facing business and I want a quick fix for the time being. Would love some recommendations.

Dermal filler for asymmetry? (Photo)

Blue facial veins can be treated in patients with darker skin tones, including Fitzpatrick skin type V, but treatment selection and preparation are important to minimize the risk of pigmentation changes.
Lasers can still be used safely for facial veins in darker skin types when performed carefully. In my practice, I typically recommend using Hydroquinone for about four weeks before treatment to reduce the risk of post-inflammatory hyperpigmentation. I usually have patients stop it a couple of days before the procedure and then resume about a week afterward. Treatments are typically performed in a series&mdash;often about three sessions&mdash;with gradually increasing energy settings to reduce the risk of complications.
If hyperpigmentation occurs, it is usually temporary and tends to resolve gradually over several months.
Regarding sclerotherapy, although it is very effective for leg veins, I am generally cautious about using it on the face. The facial skin has a different vascular structure and cosmetic tolerance is much lower. A rare but real complication of facial sclerotherapy is skin ulceration, which can take several months to heal and may leave a scar. For that reason, I reserve sclerotherapy on the face only for very select situations.
In most patients with blue facial veins and darker skin types, carefully selected vascular laser treatments tend to be the safer first option, with proper skin preparation and conservative treatment settings.

I have small spider veins around my laugh lines on face, skin type V and was wondering what the best procedure is to get rid of them. I've been told by countless HCPs that lasers should not be used and that sclerotherapy would be the safest option. Please provide any advice or recommendations. Living in Toronto Canada. Thank you!

Sclerotherapy for spider veins around laugh lines on face skin type V? (Photo)

First, proper placement is critical when using Juvederm Voluma. Ideally, cheek filler is placed deeply on the bone to restore structural support. If filler is placed more superficially or too far forward&mdash;particularly closer to the nasolabial fold&mdash;it may not provide the lift expected in the midface. When filler is placed with a cannula in softer tissue rather than directly on the bone, it can sometimes distribute differently or even migrate slightly, which can make the cheeks appear flatter rather than more lifted. Finally, the masseter toxin treatment can also subtly change facial proportions by slimming the posterior part of the jawline. As the lower posterior face narrows, the midface can appear different in comparison, which may make facial heaviness even worse even when filler is present in the cheek. Hope this helps.

So i have a before and after of 22 units per side masseter botox, 4 units daxxify lip flip and 0.7 in total cheek filler. How did my face end up worse? One cheek is almost caved in as well. I look like a picasso.

Masseter botox and Voluma cheek filler. How did my face end up worse? (Photo)

Most patients look at options of fat transfer to the hand and/ or vein removal because of aging and loss of volume. In my experience Radiesse&nbsp;works well, it&nbsp;corrects the volume loss and makes the appearance of the veins subtle. I&nbsp;at times will do sclerotherapy on hands with 2 % to 3% STS for patients wanting the veins removed after filler injections. The product cost is more with Filler but so is the predictable results and patient satisfaction.

I understand fat transfer is very unpredictable and long-term patient satisfaction is low, however regular fillers are also costly. How king does Radiesse last in the hands? A surgeon told me in ten years not one patient had come back for a top up. I heard elsewhere it can last up to 7 years - is this possible?

Fat transfer or Radiesse for loss of volume on back of hands? Vein reduction or vein removal?

I agree with Dr Grossman. Patients can feel light headed for a number of reasons. I&nbsp;generally have the patients lay down instead of elevating the legs. I recommend following up with your doctor if you have more questions

My head was literally the lowest thing, position wise, and my feet were above head-level. I always heard that it was really bad to lay down after botox and that you had to wait 4 hours. Now I'm freaking out because I think I will have some bad effects from it later. I asked the doctor "shouldn't I keep my head elevated after botox?" and she said "No, it's fine. Just lie down until you feel less lightheaded." I lay down for a few minutes. Will I have bad effects from this?

Today I got botox in my forehead. I started to get lightheaded so the doctor put my head down and my feet up. (continued)

I&nbsp;generally recommend stopping treatment and waiting. Matting should disappear over time.&nbsp;Sometimes more treatment with sclerotherapy or BBL&nbsp;can help. You should follow up with the treating physician.&nbsp;

5 months ago I had sclerotherapy on my thighs, which left huge red matted areas. Two months ago I had it done below the knee, which also caused matting. My legs look so much worse than before. I went back to get another ultrasound to check for reflux but everything was ok. I already had Evlt of large and small saphenous veins both legs and ultrasound guided sclero done last year. How should I approach treating this? Scared to make it even worse while spending more money... thanks!

What is the treatment for matting from sclerotherapy with Asclera 1% for mostly reticular veins? (Photos)

I&nbsp;would personally use a cannula and Belotero. The area to inject is the moat between the cheek and the eye and it seems like the filler was either injected too high or it moved.&nbsp;

I had Belotero fillers for hollow areas under my eyes a few months ago and they looked terrible. It looked like two huge bags under my eyes so I got them dissolved. After they were dissolved I then had these tiny ridges/bags under my eyes that were not there before and loose skin! Make up will not cover. Also some discoloration left from bruising. I am way more self conscious than I was before. What to do next?

Should I try someone else for second filler treatment? (Photos)

We treat veins on a daily basis. Staying active is encouraged post treatment. I prefer my patients to walk about a mile a day or be on elliptical cross trainer for 15-20 mins. I&nbsp;ask my patients to avoid lifting heavy stuff (&nbsp;more than 20 pounds )&nbsp;or doing high impact training (like jumping jacks) just because they can make the legs sore. There is limited evidence that compression socks impact results of spider veins treatment. There is more evidence that compression helps with symptomatic relief and impact the result of varicose and reticular vein treatment and after DVT.&nbsp;I&nbsp;recommend wearing compression for the first 24 hours after treatment and during the daytime for at least 2 weeks. As far as your soreness you can take tylenol, motrin or Aleve. Since NSAIDS work by inhibiting platelet function, they don't impact treatment results of veins.

My provider is a board certified dermotologist who wants me to refrain from excercising for 1 week. I suspect if I moved around more, I'd feel less achy but want to follow what the doctor advises. What are your thoughts? The doctor advises me to wear compression hose except for when sleeping/showering which I do. Could it be that the compression hose are causing me to feel achy.

I had Sclerotherapy 4 days ago and have joint stiffness and pain. Could it be the compression hose?

Kamran Afzal, MD

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Internists specialize in the diagnosis, prevention, and treatment of cancer, infections, and diseases affecting the heart, blood, kidneys, and joints as well as the digestive, respiratory, and vascular systems.

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Dr Afzal is the best! He’s honest, funny, and skilled in all the procedures I’ve had. I’ve been going there for quite awhile (Edina and Fridley).
I go with his suggestions and I’m always satisfied.Bri and Kaitlyn are awesome. Gentle, kind, and patient. They have an awesome team you can trust!Jan Gray

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13 Answers from Board Certified Internist Kamran Afzal, MD See Education, Board Certification, and Treatments Offered.

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Dr Afzal is the best! He’s honest, funny, and skilled in all the procedures I’ve had. I’ve been going there for quite awhile (Edina and Fridley).
I go with his suggestions and I’m always satisfied.Bri and Kaitlyn are awesome. Gentle, kind, and patient. They have an awesome team you can trust!Jan Gray

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