What is best way to treat my lower face sagging? (Photos)

Question

Hello, i am 37 years old . I have always had a "sad" looking lower face. Andi want to fix that. But i am lost between all the options : morpheus8, Aptos thread lift, fillers ... My concern is mainly marionette lines and mouch corner pointing downword. I also don't like my chin , so i am open to suggestions. Thank you.

Nelson Lee Novick, MD · Answer

Fillers are the simplest approach and one that achieve immediate, on-the-spot results while engendering little to no significant post-treatment downtime. Relatively expensiive RF devices, while faddish and touted as "the next big thing" remain more backed by heavy marketing hype than hard science. Aptos threads, which I gave up performing well over fifteen years ago, engender downtime and run the risk of infection and skin dimpling that can be quite troubling. So, "buyer beware" when it comes to either of these approaches. On the other hand, fillers fit the rule of "Keep it simple," which is usually the best route to take. Just make sure to consult with a board certified cosmetic dermatologist and be certain to ask to see his/her personal befores and afters prior to agreeing to proceed. Best of luck.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

You have obviously explored many avenues to achieve your desired changes with nonsurgical treatments.

It seems unlikely that further efforts along these lines would be more successful.

A short scar deep plane facelift is more likely to achieve the combination of changes that you seem to wish for in the lower face and will also impact the appearance of the area under the chin.

It does of course mean the presence of the scars and this may be something you wish to avoid.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. You would likely benefit most from a combination of facial liposuction and injectable filler treatments. By removing submental fat below the chin, both the chin and jawline can appear more defined to provide a natural and youthful contour.

Dermal fillers are an excellent option for addressing marionette lines and the corners of the mouth for a soft and lifted result. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and suggest the best options for helping you achieve your aesthetic goals.

Jason Emer, MD · Answer

For a double chin, InMode FaceTite with VASERlipo would give you the best result.

With significant neck sagging you would need a facelift / neck lift with muscle tightening (platysmaplasty). At the same time, I would recommend lasers (Fraxel, CO2, Halo, or Erbium) and microneedling RF (Fractora, Morpheus8, PiXel8, Intensif) to improve the crepey skin and wrinkles. Overall, the neck can be treated with a combination approach:

1. Microneedling and laser treatments for texture
2. Botox, Dysport, Xeomin or Jeuveau to help platysmal bands
3. Intensif, Fractora, PiXel8, or Morpheus8 microneedling RF for crepey skin and lifting
4. Injectable fillers like Belotero, Restylane Silk, Versa, and Juvederm Volbella to improve lines and folds
5. Face/neck lifting if sagging is prominent or premature, with or without platysmaplasty (muscle tightening)
6. Renuvion (J-Plasma), ThermiRF, and InMode FaceTite/AccuTite for internal tightening
7. Ultherapy and Thermage for external tightening
8. Regular Venus Legacy, Exilis Ultra, or InMode Forma treatments with facials to maintain tightness
9. PDO NovaThreads or Silhouette InstaLift cone threads for lifting and long-term collagen production

See an expert for a formal evaluation and to develop a personalized treatment plan based on your individual situation and goals. Best, Dr. Emer

Brian M. Harmych, MD, FACS · Answer

Thank you for sharing your questions and photos. You don't have enough facial aging to warrant a neck lift or facelift. Liposuction along the jawline and under the submental neck would yield sufficient improvement. Further improvement could be obtained with volume augmentation along the chin and jawline. Options for this area include surgical and nonsurgical, fillers, fat transplantation, small chin implant. All of the above options can be safely and comfortably performed under local anesthesia. I hope you find this answer helpful. Best of luck!
Kind regard,
Dr. Harmych

Zoran Potparic, MD · Answer

Based on these photos, you are not candidate for neck/face lift, too early. Conservative liposuction of anterior neck and jawline would be sufficient. Fillers for the corner of the mouth. Good luck.

Brian K. Machida, MD, FACS · Answer

Your condition is not very severe based on photos. I don’t see any marionette lines, only prominent oral commissures. Morpheus8 will do minimal results toward your goal. Fillers may be the best targeted treatment of this area.

Robert Singer, MD · Answer

Everyone ages at a different rate. Some patients at 37 have more aging than those much older. It depends on numerous factors including: heredity, history of smoking, lifestyle, sun exposure, excessive exercising, underlying medical health, and significant weight loss.

Today, many patients opt to undergo a facelift at 37 or younger. It really depends more on the extent of aging, desired outcome, realistic expectations, individual anatomy and if the aging process bothers you enough to do something about it. Since every patient is different, the approach to facial rejuvenation (fillers, micro-fat grafts, mini facelifts, facelifts, and combination of procedures) needs to be individualized in order to achieve a natural appearing improvement.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Darryl J. Blinski, MD · Answer

Thanks for posted photos. Since you have attempted and are unhappy with non invasive and minimally invasive options I recommend invasive mini FL/NL w SMAS plication, nano/micro fat grafting to marionette/naso labial/mandibular jugal groves. Fees $10,000. Best to virtual consult with...

What is best way to treat my lower face sagging? (Photos)

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