How to balance my face? Concerned about flat face, double chin, weak chin and sagging. (photo)

Question

Hi I'm looking for advice on how best to balance my features, I feel I have a very flat face that is making me look old. I am only 28 but feel like my facial skin is sagging already. I have not had any drastic weight loss. I have a double chin front on because of my weak chin therefore have a sagging neck. How can I improve this?

Anna Chacon, MD, FAAD · Answer

First, I want to reassure you that nothing in your photo suggests severe sagging for someone who is 28. What I think you’re noticing is a combination of facial structure and soft-tissue distribution, which can create the impression of looking older even when the skin itself is still relatively youthful.

From your description and the photo, the features that seem most relevant are:

Mild chin retrusion (a weak or under-projected chin)
Reduced forward projection of the midface, which can make the face appear “flat”
Fullness under the chin, which becomes more noticeable when the chin is set back
A relatively soft jawline-neck transition, which can be mistaken for true neck sagging
The weak chin is likely the biggest factor

A recessed chin can create the illusion of both a double chin and a sagging neck, even in people who are not overweight. When the chin sits farther back, the tissues beneath it have less forward support, so the area under the jaw tends to look fuller from the front and side.

This is why many patients are surprised that improving chin projection often makes the neck look tighter without directly treating the neck.

What would likely create the most balance?

If I were prioritizing treatments based on facial harmony, I would focus on structure first, skin second.

1. Chin augmentation (most impactful)

A small to moderate increase in chin projection — either with hyaluronic acid filler or a chin implant — can:

strengthen the profile,
reduce the appearance of a double chin,
improve the jawline,
and create a more balanced relationship between the nose, lips, and chin.

For someone your age, this is often the single highest-impact non-surgical change.

2. Submental fullness (under-chin area)

If there is a true pocket of fat under the chin, options include:

Kybella/deoxycholic acid injections,
submental liposuction,
or energy-based tightening treatments if the fullness is mostly soft tissue rather than fat.

However, I would not treat the under-chin area before addressing chin projection, because sometimes the fullness looks much less prominent once the chin is brought forward.

3. Midface support

Your face does not look dramatically hollow, but adding subtle cheek or midface support can help with the “flat face” concern by restoring a bit more anterior projection rather than simply adding width.

The goal would be gentle forward support, not exaggerated cheekbones.

About the “sagging” feeling

At 28, what patients often perceive as sagging is actually:

loss of contour definition,
shadows created by facial anatomy,
or skin laxity that is still very mild.

True lower-face sagging severe enough to require a facelift would be unusual at your age unless there were significant weight changes, connective tissue disorders, or other contributing factors.

Would skin-tightening treatments help?

They could help a little, but I would consider them secondary in your case.

Treatments such as:

radiofrequency microneedling,
Ultherapy/HIFU,
or RF skin tightening

may improve skin firmness and jawline definition modestly, but they will not correct a structurally weak chin.

My honest impression

Based on your photo and concerns, I think the issue is more about facial projection and support than premature aging.

The combination that would likely provide the most noticeable improvement in facial balance would be:

Conservative chin augmentation
Assessment of any true submental fat
Optional subtle midface support if needed

I would be very cautious about jumping straight to aggressive skin-tightening or surgical neck procedures, because I do not think you have the kind of advanced laxity that would justify that approach at 28.

The encouraging part is that structural improvements tend to look very natural in younger patients, and even relatively small changes in chin projection and lower-face support can dramatically reduce the appearance of a double chin and create a more defined, youthful profile without making you look overdone.

Nelson Lee Novick, MD · Answer

All of the problems here can be addressed via the use of appropriately robust HA volumizing and lifting fillers. The jawline can be straightened and defined; the chin augmented to improve projection and further straighten a jowly jawline while improving and harmonizing the projection of the chin with the projections of the lips and nose; and the marionette lines can also be improved. You would be wise to make sure to consult with a board certified cosmetic dermatologist filler expert. Best of luck.

Eric M. Joseph, MD · Answer

Based on your facial profile photo, you appear to have a lovely nasal profile appearance, however, you have a bit of a weak chin and excessive neck fat that may be the cause of a poorly defined jawline. Since you are 28 years old, I would suggest a surgical path so you could achieve a permanent result. Please consider meeting with several reputable facial plastic surgeons who offer computer Imaging so you can see what might be best for you moving forward. I hope this helps! Sincerely, Dr Joseph

Camille Cash, MD · Answer

From your photo and stated concerns it seems you would benefit most from a combination of treatments.  Fillers can be used to add volume, give a lifted look to the cheeks, and sculpt facial contours.  Morpheus8 can be used to improve overall skin tone and texture.  We always recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Cengizhan Ekizceli, MD · Answer

Hello, thank you for your question, we suggest double chine Liposuction + J PLASMA for more tightening 
If you want to check the doctor's Instagram page, I added the link, you can take a look and have an idea about the surgery.
We can offer you a virtual consultation for a better evaluation, please send us your full name and phone number on our email: hi@estherianclinic.com. We will contact you as soon as possible.
Hope it helped!

How to balance my face? Concerned about flat face, double chin, weak chin and sagging. (photo)

Answers (5)

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