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.

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