What procedure would help? I'm likely too young for a facelift (Photo)

Question

My cheeks are beginning to sag and jowl. I'm 28, so I imagine most surgeons wouldn't recommend a facelift, though I'm open to it. I have lines around my mouth, more fullness in my lower face, full rings of hollowness all the way around my eyes (half circle), and I can feel fat around my jaw in bumps that weren't there a few years ago (feels like cheek fat moving down). It's not exactly in the buccal area. What would you recommend? I do not want fillers. Thanks!

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

The first thing to consider is whether you are proactive with protecting your skin using sun block. The elasticity of the skin is affected by ultraviolet light and regular use of sun block is an important part of maintaining a more youthful appearance.

Thread lift interventions have been designed for situations like yours. I do not have personal experience with such treatment but it would be worth having an opinion about suitability in your case.

A more invasive approach would be a minimal access facelift which involves a scar hidden within the side burn and it is effectively a superficial midface lift. It can be complemented with fat transfer to achieve a change in the balance of the facial volumes and the distribution of the highlights and shadows over the face.

Pasha Mostofi, MD, DMD · Answer

Hello there! A great option for you would be microneedling with radiofrequency (for example Morpheus8). 
This is a handheld device that uses many tiny needles and radiofrequency waves on your skin to help create a form of controlled skin injury. The damage stimulates growth of healthy new skin and promotes some collagen formation to restore volume. This can help with not only skin laxity, but fine wrinkles and even some acne. Normally, a patient may receive three treatments, either under local anesthesia (numbing) or sedation (depending on the intensity level chosen) spaced one month apart. I have personally had this treatment done myself and performed it on many patients. This is a great therapy for you to explore with your chief complaint.

Lexie Wang, MD · Answer

Hi! If you don't want filler, another option to consider could be fat grafting (similar to "permanent filler" in concept because it involves using your own tissue). Another option could be a midface lift. I absolutely in your case would not recommend doing any "removal" type procedure (buccal fat/lipo/etc.) because what you need is holding on to volume so that you don't get the pull from gravity. Good luck!

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. This is a great question. Based on your concerns, I recommend treating the area with dermal fillers or trying a laser resurfacing treatment. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Ajaya Kashyap, MD · Answer

Thank you for your query. You will benefit from non surgical facelift treatments for your lower face contouring , like invasive radio-frequency and HIFU , and  nano-fat grafting for the hollows under your eyes. Please find an experienced Board certified plastic surgeon who can examine you and help you with all your concerns. All the best!

Connie Hiers, MD, FACS · Answer

You would do well with a nonsurgical, no downtime micro-needling with radiofrequency treatment called Secret. It is 3 treatments done monthly. As you age, you can boost as needed.

Burak Fatih Efeglu, MD · Answer

Best Greetings,
You can try the PDO Threads out they can prove it. For a Facelift surgery you are too young.

John W. Tyrone, MD · Answer

There are a few different treatments that may help address your concerns. Starting with a treatment like PRP micro-needling, micro-needling with exosomes, or RF micro-needling to address the laxity and then following with dermal fillers to help replace some of the volume loss in other areas can help prolong the need for a surgical facelift.

Darryl J. Blinski, MD · Answer

Nice posted photos. Since you refuse fillers I might offer mini face/neck lift with SMAS plication with micro/nano fat grafting . Fee $12,000. Best to virtual consult with....

Mats Hagstrom, MD (license on probation) · Answer

Facial aesthetics are primarily determined by bone structure. What differentiates those who are perceived, as more attractive versus those who are not, masculine versus feminine are generally primarily based on bone structure. Soft tissue coverage tends to be far more consistent and the individual appearance of each person is more related to skeletal structure.
For that reason, soft tissue attempt at treating something which is primarily determined by bone structure, is going to be inherently limited. A facelift is not the right treatment in your case.
If you want an accurate facial assessment regarding bone structure and consult with oral surgeons or plastic surgeons, who have the proper cranial facial surgery backgrounds
A cephalometric assessment can help determine what ratios are out of balance, and help understand what treatments are likely to work, and which ones will not.
Getting a quality assessment it’s not always easy or straightforward. Treatment options, addressing the primary underlying issue may also not be appealing or appropriate for everyone.
Best,
Mats Hagstrom, MD

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