I’m 35 but feel I have significant sagging. What procedures should I consider? (photos)

This is not fat but formed from a muscle confluence ending close to the corner of the mouth. At some point, it can be lifted with a deep plane lift. Also in case you were wondering, it is not buccal fat and cannot be treated with buccal fat removal.

​Fillers such as Restylane Silk, Belotero, or Juvederm can work well to treat lines around the mouth, but the best first option is laser resurfacing or deep peels to induce collagen production. Superficial radiofrequency devices and microneedling can help as well and are less invasive. I suggest going to an experienced cosmetic dermatologist with expertise in lasers and fillers. Best, Dr. Emer​

Hello, and thank you for providing photos along with your question. Based on these images, it appears significant volume loss has made the muscles on the side of your mouth more prominent. Fillers may help restore volume, enhance facial contours, and improve symmetry and facial balance.

For a longer-lasting approach that will provide more dramatic results, you may opt for a mini lift. A mini facelift is a minimally-invasive surgical procedure that’s less aggressive than a traditional facelift (rhytidectomy) or a neck lift with platysmaplasty. A mini facelift might be your best choice if you have early signs of aging, such as slight jowl formation and mild to moderate skin laxity.

I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. Whether injectables or surgery, specific techniques and steps for performing the procedures can vary from surgeon to surgeon. It is essential to find the most skilled and experienced facial plastic surgeon to perform your procedures to make the lasting improvements you want. Because facial plastic surgeons only perform procedures on the face, their knowledge of facial anatomy and refined techniques ensure you enjoy the best possible results from your procedure.

Hello,
Thank you for your question. I can appreciate the "balls" you mentioned. This is best corrected with a minifacelift. You are certainly on the young side for this so you could consider FaceTite and Morpheus8 but this will never provide a facelift result. I wish you all the best.
Mark G. Albert, M.D., F.A.C.S.New York, NY and Boston, MA

Thank you for your enquiry and sharing your photographs. In general, maintenance facelift surgery is a procedure that requires careful consideration because of the alternatives.

In your situation, the jawline contour is good and the main problem seems to be related to laxity in the nasal labial and of the corner of the mouth. You can opt for volume authentication but essentially it will lead to slight excess in the volume around the mouth and presumably too much compared to the appearance at the age of 20.

I suggest that the best analysis you can make would be to look in the mirror lying completely flat without a pillow. This repositions the volume of the buccal fat and enhances the contour of the jawline. It creates and effect that shares many similarities with a short scar facelift intervention. If you like the appearance of the lower face and jawline, they deep plane technique is likely to provide you with a comparatively similar outcome.

Unfortunately, computer simulations for the appearance of the face on the front view don't work particularly well even in 3-D imaging.