Facial Drooping 6 Months After Lower Face Botox - could more filler fix this? (Photos)

Question

I had Botox in my lower face six months ago, and since then, my skin seems to have drooped forward. I’ve already had a syringe of filler in each cheek to help, but it hasn’t been enough. I’m only 36 and not ready for a facelift—could more filler fix this, or are there other options?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It's understandable that you're concerned about the drooping you've noticed in your lower face following Botox injections and that the cheek filler hasn't provided the desired lift. Botox in the lower face, while sometimes used to address specific concerns like a gummy smile or downturned mouth corners, can, in some individuals, weaken the muscles that provide support to the lower facial tissues. This weakening can potentially contribute to a feeling of heaviness or drooping, especially if there was already some degree of underlying laxity. While you've tried addressing this with cheek filler, which can help restore midface volume and indirectly provide some lift, it might not be sufficient to counteract the muscle relaxation effect and the resulting tissue descent. At 36, wanting to avoid a facelift is a common sentiment, and there are indeed other options to consider. More filler could potentially provide additional lift and support in the cheeks and even along the jawline to help redefine the contour and address the perceived drooping. However, it's crucial to have a thorough assessment to determine if further filler is the most appropriate and sustainable solution. I hope this helps and best of luck!

Michael A. Persky, MD · Answer

Hello Abtone,
I would treat you with a combination of strategically place Sculptra to biostimulate facial volume where you need it along with Ultherapy of your face, a non-invasive microfocused ultrasound energy treatment that takes an hour and will lift and tighten the skin and muscles of your face giving you a natural refreshed lifted appearance.  As with any aesthetic treatment it is most important that you choose your treating physician very carefully.  Feel free to contact me with any further questions or concerns.  Good luck and be well.
Michael A. Perskky, MD
Encino, CA

Anna Chacon, MD, FAAD · Answer

Facial drooping after Botox can be concerning, but there are several options to address this issue besides additional fillers. Here are some potential approaches:

Additional Filler Placement: While you've already had fillers in your cheeks, strategic placement in other areas, such as the jawline or nasolabial folds, might provide better support and lift to the lower face.

Sculptra: This is a biostimulatory filler that stimulates your body’s own collagen production, offering gradual volume restoration and skin tightening over time.

Radiofrequency or Ultrasound Treatments: Non-invasive procedures like Ultherapy or Thermage use energy to stimulate collagen production and tighten the skin, potentially improving drooping without adding volume.

Thread Lifts: A minimally invasive option, thread lifts use temporary sutures to lift and tighten the skin, offering a subtle lift without surgery.

Microneedling with Radiofrequency: This combination can improve skin texture and firmness by stimulating collagen production, which may help in reducing the appearance of drooping.

Skin Tightening Lasers: Fractionated laser treatments can tighten skin and improve texture, potentially reducing sagging over time.

Before proceeding with any additional treatments, it’s important to consult with a board-certified dermatologist or plastic surgeon who can assess your specific situation. They can provide personalized recommendations based on your skin type, the extent of the drooping, and your aesthetic goals. They will also help ensure that any treatment plan minimizes risks and aligns with your desire to avoid more invasive procedures like a facelift.

Camille Cash, MD · Answer

You may want to explore Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Three sessions are typically recommended for optimal results.  Morpheus8 can be combined with other treatments such as Botox and fillers.  I've included a video I hope you find helpful.

Leonard Grossman, MD · Answer

The reason people notice more drooping in the face is because they simply lose volume, which is represented in terms of mostly fat and some muscle bulk. The single best way to restore the youthful appearance of the face such as yours is with the use of fat transfer. Fat grafting in the right hands( plastic surgeon) produces natural and permanent results. at the same time, you should look at least 15 to 20 years younger but exactly like yourself. I hope this helps and good luck from Organic Plastic Surgery Nyc.

Darryl J. Blinski, MD · Answer

Based on your series, post photos in the history, given options could include at least 4 to 8 syringes of filler to cause an elevation by expansion of the depressed or lack areas expect fees to range from $4000-$8000. Next option are minimally, invasive: Endo lays for face under local anesthesia with intervenous sedation fee for that is $5000, fat grafting with syringe liposuction to all areas of face fee is $8000, mini face necklace with muscle plication option fee $6000. So you see there are options. Best to do virtual consultation to discuss in more detail. Regards

Facial Drooping 6 Months After Lower Face Botox - could more filler fix this? (Photos)

Answers (6)

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