What procedure would you recommend for light sagging in the lower face for someone in their early 30s? (Photos)

Hi Doctors, I'm in my early 30s and I have noticed significant changes in my skin over the last 4 years. Every year it seems to be getting increasingly worse at a faster pace. I've noticed my face shape seems to have changed (more square), and there is slight drooping around the mouth area, cheek area appears more hollow, nasal-labial fold lines are deeper, and my pores are a lot larger. What would you recommend to treat this, and then how can I take better care of my skin to slow the process?

Doctor Answers 14

Skin Rejuvenation by the ages: non-surgical, minimally invasive and surgical options

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Dear WSS_135:
You are very perceptive and show the beginnings of facial skin laxity. The skin stretches and elongates developing a growing “wave” at points of attachment such as the:
  • hooding along the eyes,
  • lower eyelid / cheek junction or tear trough / nasojugal fold,
  • nasolabial fold,
  • lateral mouth commissure and marionette folds,
  • jowls and neck.
Since I do not have the advantage to examine you, I hope you will be helped by the information below.
My immediate recommendations include:
  • Consultation with a talented, Board Certified Plastic Surgeon with extensive skills in:
  • non-surgical skin tightening
  • minimally invasive injectables
  • surgical options, as required.
Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone.
During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend. 1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle.
  • Exfoliation is best for this using:
  • microdermabrasion,
  • Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis,
  • Some lasers and chemical peels.
  1. The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of:
  • fillers (Restylane and Juvederm), or
  • Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells.
  • Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis
3. The next layer or fat also thins or droops with age and maybe:
  • filled (Restylane and Juvederm), fat grafting or
  • redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts / cheek)
  1. The muscle which creases the skin into wrinkles and folds is weakened and rebalanced with
  • Botox or similar injectable muscle relaxers like Dysport or Xeomin.
  1. Bone also undergoes a dynamic process of resorption, thinning and descent. Options for cosmetic enhancements include:
  • implants
  • structural fillers, particularly like Radiesse (bone mineral)
  • volumizing gel fillers like Juvederm and Restylane
Facelift, necklift and forehead lift are surgical procedures which include:
  • an incision along the periphery of the tissues
  • a suspension or re-positioning of the underlying soft tissues, and
  • a redraping of the skin with removal of skin excess.
A sub-group to the facelift is the mid-face lift. This is used to detach the soft-tissues of the cheek which have descended, separated and lost volume and suspend them to the lower orbital rim. Generally, the fat pockets under the eyes are trimmed or added to the volume of the cheek and the eyelid skin is redraped. 
Don't forget to protect your skin from the elements! UV blockers, anti-oxidants, pigmentation control and oil reduction will maintain your skin rejuvenation efforts. Consult with a Certified ZO Skin Health Specialist!
Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon or ENT Facial Surgeon with great experience to evaluate your needs and find a plan that works best for you.
All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.
I hope this was helpful! All the best!

Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Facial changes at 30

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Thank you for asking about your facial changes.
  • You are very observant - it is true we all start to see changes in our late 20s, early 30s.
  • Based on your photos, you might consider Botox in the masseter to narrow the face.
  • Filler to the cheeks, nasolabial and marrionette areas.
  • Microneedling for large pores. 
  • A skin care program along with microneedling, such a Vitamin C + tretinoin + sunblock will help to correct facial damage from sun and time and slow down changes in the skin.
  • No smoking and staying out of the sun to a reasonable extent will help as well.
  • If the changes have led to excess fat appearing under the chin, liposuction can correct that.
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Lower face/perioral corrections in early 30s

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Based on these photos you may consider conservative  correction of corners of the mouth (Marionette lines) and nasolabial folds with fillers. Full face photo or clinical exam would reveal whether additional volumization of cheeks or chin would benefit re-creating round, youthful face.
You should consult an experienced board certified plastic surgeon with good reputation in facial rejuvenation to discuss your options. Try to avoid "certified injectors" of any kind. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

What procedure would you recommend for light sagging in the lower face for someone in their early 30s?

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Your very young and have excellent skin and a nice young full face.  I would definitely avoid surgery at this stage in her life.
Dermal fillers placed into the mid face and cheek region can create full apple cheeks and lessen the appearance of fullness that you see in the lower face area. A long-lasting filler such as Voluma would be my choice.

Aging at 30... It's just the beginning but do not panic.

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Thanks for sharing your question. I can appreciate your concern.
The changes that you experience are just the beginning of the aging process. However, there are minimal and not to complex to address.  In your case the use of lasers, and fillers may provide the changes to preserve the youthful look to your face. Extreme weight loss may favor the changes that you are describing. 
Finally, make sure that you have a consultation with a board certified plastic surgeon.
Wishing you the best in your journey

Skin treatment in your early thirties

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WSS_135,      At your age, I would definitely start with more conservative therapy.  Fillers are a great starting point, and could be used around the corners of the mouth, to fill in this area of concern.  Also, Voluma is filler that can be placed in the cheek (conservatively) to help re-establish a heart shaped face, rather than a rounder shape.  Of course, regular UV protection (sunscreen, SPF makeup) is one of the most important things you can do to slow aging changes.  It is difficult to assess your pore size, and overall skin condition from pictures, but some topical therapies may be able to help as well.

John Harbison, MD
Omaha Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Facial aging in the early stages

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Thank you for the photos and your questions. Generally, at your age, skin care is the best place to start. This would include a complete program of tretinoin, sunscreen, moisturizer, etc. Beyond this, gentle treatment with fillers for early marionette folds could be considered. Botox can be used in the masseter muscle to make the jaw look a little slimmer -- though this is not specifically related to aging. As a final step, for patients who develop early jowls or laxity along the jawline, ThermiTight can be a fantastic solution. This is a minimally-invasive radiofrequency treatment that tightens the skin and reduces some fat volume. Take care!

Facial Maintenance

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It appears from your photos that fillers would be all you need at this time.  You have a pretty face and if you do too much you run the risk of looking over done or fake. Be sure to consult with a board certified plastic surgeon. Good luck!

Robert M. Tornambe, MD
New York Plastic Surgeon
5.0 out of 5 stars 33 reviews

Lower Face

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Fullness is actually a good thing.   I do not really see much to recommend other than possibly some fillers around the corner of your mouth.  I would really like to see a side view to assess the strength of your chin.  
However be very careful that you go to someone who will make sure that they do not do too much.  Unfortunately there are various kinds of practitioners out there who think money first and patient second.  You want to find someone who will think of your welfare first and foremost.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

Non-surgical facelift options

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Given your age, I don't think you are anywhere near ready for a facelift. You might benefit from a bit of filler around the corners of your mouth. And always smart to start using a high quality skin care line and sunscreen at your age. Schedule a consultation with a board certified plastic surgeon in your area to be assessed in person and discuss options.


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.