32, F, asymmetrical sagging - What facelift or procedure is right for me? (Photos)

Question

Hi everyone! I am a 32-year-old female seeking advice on early facial aging. Over the last few years—following a stressful period of grieving—I have noticed a distinct midface drop and subtle changes around my eyelids. The aging is quite asymmetrical; I have a noticeable jowl on one side of my face that really bothers me, while the other side is relatively smooth. My History & Treatment Goals: The Problem: Mild but asymmetrical midface sagging and a prominent single-sided jowl. Prior Procedures: I had a fat transfer to my cheeks, chin, and lips 2 years ago. I also had a HIFU (High-Intensity Focused Ultrasound) treatment, which actually made my jowl look worse and more deflated. What I Avoid: I do not trust non-surgical energy devices after my HIFU experience, and I absolutely do not want dermal fillers. I am looking for a permanent, structural fix. Preferences: I prefer minimal visible scarring, a shorter duration under general anesthesia (or deep sedation), and lasting longevity. Given that my sagging is early/moderate but asymmetrical, which approach would you recommend? I am researching endoscopic midface lifts, SMAS facelifts, and deep-plane facelifts. I’ve read that endoscopic lifts have shorter scars but may not last, while deep-plane lifts offer incredible longevity but require a longer incision.

Serdar Bora Bayraktaroglu, MD · Answer

For early, asymmetrical facial aging and a prominent single-sided jowl, non-surgical devices and temporary fillers are insufficient. An endoscopic midface lift targets the cheeks rather than effectively correcting a descended jawline or jowl. Instead, a targeted lower or SMAS-based approach provides the necessary structural correction. Both SMAS and deep-plane techniques address underlying fascial layers for long-term durability and symmetry, though incisions around the ear are required to properly redistribute tissue. Consult a board-certified plastic surgeon specializing in facial rejuvenation to evaluate your anatomy and determine the precise surgical vector for your asymmetry.

Manuel Diaz, MD · Answer

Hello. At 32 years old, with the excellent facial structure and skin quality you see in the photo, you're not a candidate for any type of surgical facelift (whether endoscopic, SMAS, or deep), as the scars and risks of major surgery far outweigh the benefits of addressing sagging that is medically insignificant. The asymmetry and that small bump you notice on your jawline are usually due to muscle tension from stress or bruxism (masseter muscle hypertrophy) or the settling of a previous fat graft, rather than actual tissue sagging. Since you prefer to avoid fillers and energy technologies, the most recommended, safe, and least invasive solution is to apply Botox (botulinum toxin) to the masseter muscle or the platysma muscle bands in your neck. This will relax the area, refine your facial contours, and easily restore symmetry without the need for surgery.

32, F, asymmetrical sagging - What facelift or procedure is right for me? (Photos)

Answers (2)

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