24, thin, pre jowls & fat/puffy lower face. Discouraged from facelift but I've tried injectables w/ no avail. Options? (Photo)

Thanks for your question and
photos. I would agree that further fillers or fat transfer will simply make
your face more puffy, with the exception of the nasolabial folds, which could
be softened. It is difficult to tell without an in-person consultation, but I
agree that in patients with full faces, buccal fat pad partial removal through
an intraoral approach can be very beneficial. You do look like you would
benefit from fat removal underneath the chin, and possibly a little at the jowl
area. The smoothest, most complete results can be achieved with laser PrecisionTx
(from Cynosure) fat removal treatments, which will also result in some modest
tightening and can be done as an office procedure with minimal downtime.
Midface lifts (via a short scar sub-SMAS dissection) can sometimes be very
useful in younger patients like yourself, but only if there is significant
tissue laxity, which can only be determined by an in-person consultation. It is
important to get several opinions and carefully review the surgeon's experience
and reputation. Good luck with your decision.

I agree with your consultation that you do not need a facelift. It does appear that you have some subcutaneous fat around the jowl area. That being said a combination of liposuction with possible non-invasive skin tightening like thermage or ultherapy may be helpful. The best thing is to see a board certfied plastic surgeon and get all the options. I hope this helps!Ritu Chopra MD

Thank you for your photo and for sharing your photos.  Ultimately, a surgical face lift provides the best contouring for someone with moderate or severe laxity. This procedure could include tightening your underlying musculature to give you a better contour and also removing the excess skin laxity. Together this allows for a much better face and neck contour. In some instances, some liposuction is also beneficial to reduce the submental fullness. However, this may not be route you want to explore based on your photos as you don't have much laxity.  However, there are effective non-surgical options for you. I would recommend Ulthera if you are looking for something with no downtime, or Profound if you could tolerate some downtime. Ulthera is an ultrasound based energy that heats the underlying tissue and stimulates collagen in response. Profound is a radio frequency microneedling device that allows for the creation of Elastin, collagen and hyaluronic acid and hence restores some of the lost elasticity in the face. It has more visible downtime with the possibility of some swelling and bruising that diminishes in about a weeks time.Dermal fillers may also give you more cheek (mid face) definition and soften the jowls to a lesser degree than surgery, but create a nice contrast. In addition, Kybella for the neck region would help define this region without surgery. Lastly, you may want to consider Botox for the masseter region as this can help thin the lower sides of the face which is a result from masseter hypertrophy (due to jaw clenching).I would visit with a board certified plastic surgeon who has the portfolio of non-surgical options in your area who can help explain the treatment options for you and the limitations of each option, both surgical and non-surgical.

 Thank you for your pictures. I hear your concerns loud and clear. In my Pinyan you do not need any type of aesthetic procedure. Sometimes the best answer is no treatment at all.  Best wishes  

Facelifts are typically not performed on patients your age so you will be hardpressed to find a surgeon that wiill recommend it for you.  A less invasive option would be submental liposuction and a midface lift.  

Hello,

Thank you for your question.

Based on your goals, you may want to consider
procedures such as a genioplasty and/or buccal fat removal. 

I'd recommend booking a consultation with a
Board Certified Plastic Surgeon to determine what your options would be.

Take care.

I agree with your surgeon that  facelift is probably not indicated for you right now.  I would consider some Kybella to help dissolve the fat in your neck and around your jawline.  Consultation with someone in your area with experience with this treatment may be worth your consideration.  The Kybella website can help you find doctors in your area.  Best of luck.

You certainly do not need a facelift. The photographs aren't complete but liposuction of the chin and neck might be of benefit. This procedure can be performed under local anesthesia. I also see case for volume enhancers but I'm not certain what you have had in in what location previously.

Thank you for a great question and for sharing your photos and experience. I am sorry to hear that you did not obtain the results you wanted.  However, I absolutely agree that you are too young and do not have enough laxity evident on the pictures to warrant an invasive facelift.I think you look great, but I know we are our own worst critics.  There are some noninvasive skin tightening treatments such as Pelleve or Ulthera, and minimally invasive laser liposuction techniques (Precision Tx) that can provide contouring of the fat and stimulate a tightening effect on the skin that may be considerations for you.I recommend consulting with a board certified facial plastic surgeon to further discuss your concerns and options."This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Patients with lower face fullness and and small jaw formation could benefit from cosmetic plastic surgery.Lower face fullness could be improved with buccal fat pad reduction in patient candidates. buccal fat pad removal helps to achieve a chiseled lower face appearance in patient candidates.Small jowls could be improved with cheek augmentation with fillers. By adding small amount of fillers in the anterior and lateral cheeks, this will give a lifting effect to the lower face, improving the small jowls in patient candidates (without the need of surgery specially in young patients)Patients interested in a cosmetic improvement of the face  should make a consultation with a Board Certified Plastic Surgeon specialized in cosmetic plastic surgery of the face
John Mesa MD
Board Certified Plastic Surgeon
New York City (#NYC) & New Jersey (#NJ)