Liposuction or facelift of some sort to fix fullness in my lower face? (Photos)

Question

I've never experienced significant weight loss and remained a healthy BMI. I do not have EDS. I've always been bothered by fullness inmy mid/lower face, the perioral area, jowls, jawline, and low cheeks. Even as a young teen, I noticed heaviness and shadowing in these areas that gave my lower face a saggy appearance and emphasized folds/lines. In the past few years (and significant stress), this is more noticeable. I can now see the fullness in the perioral mound and the rounded, puffy areas on either side of my jaw even when viewing my face straight on. I've circled these areas in the photos. I'm struggling to determine whether the issue is primarily excess fat/volume or true tissue descent/laxity, and whether liposuction or a facelift-type procedure would be best. I'm very young by facelift standards, and my skin quality appears good. When I pinch or stretch the skin, it snaps back well. The tissues feel plump but not very taut/firm, and pressing on some areas smooths the contour. I feel saggy/doughy. I see the greatest improvement when I pull my facial tissues toward my ears, which is closest to my ideal appearance. I can gather a noticeable amount of tissue when doing this, which makes me wonder if lifting is necessary. The heaviness/droopiness is much more apparent when I look down. I'm unsure whether this is true tissue descent or simply gravity on excess facial fullness. Does this look like excess tissue or descent and which procedure would achieve desired results?

David Hill, MD · Answer

Your photos answer the question on their own: your lower face looks good with your head neutral, and the heaviness only appears when you look down. That gravity-dependence means this is mobile soft tissue, mostly skin laxity, not the fixed descent a facelift is built to correct. Chin-down photos exaggerate everyone, so you actually present much closer to your head-up image than your head-down one. With your age and genuinely good skin quality, surgery is low on the list here. At most this is a conservative contouring conversation, at most an endoscopic midface lift.

Semih Yildiz, MD, FEPOBRAS · Answer

The visible photo shows mild perioral fullness and shadowing, but not obvious severe skin laxity. In this area, the right treatment depends on whether the fullness is fat, normal cheek descent, skin laxity, dental/skeletal support, or simply natural facial anatomy.

Liposuction is usually most useful for a true fat pocket under the chin or along the neck, and it can be risky around the perioral mound because removing too much can create irregularity or premature hollowing. A facelift or lower facelift is more appropriate when the main issue is tissue descent and jowling, not just fullness. For some patients, small-volume contouring, chin/jawline balance, skin tightening, or no surgery may be better than aggressive fat removal. An in-person exam is needed to pinch the tissues, assess skin tone, and decide whether this is a fat problem, a laxity problem, or a facial balance problem.

Liposuction or facelift of some sort to fix fullness in my lower face? (Photos)

Answers (2)

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