25, premature aging & feel like I have jowls forming - what can I do to fix my face? (Photos)

Question

Hello. I am 25 with some premature aging. Loose skin runs in my family. I lost some weight and I’m really seeing it in my face. My tear troughs make my face look so much older and I feel like I have jowls forming. I think I might be too young for a facelift, and I would love to stay away from fillers. Do I need to go get surgery? If so; which ones? Or can I improve this look with medispa stuff such as ultrasounds or lasers or Microneedling?

Jacob Tower, MD · Answer

Hello, hope you are well. Unfortunately weight loss can also cause volume loss in the face, as you have pointed out. I would suggest avoiding anything invasive until you are confident that your weight has generally stabilized. For the tear trough area, you may consider a trial of dermal filler, but a more permanent correction can be achieved with fat grafting which can be performed under local anesthesia. For the lower face, to tighten the skin and slim the jawline (where you see early jowling), you might consider RF-energy based treatments including Morpheus8 (RF microneedling) and FaceTite (bipolar RF). 
Best,Dr. Tower

Donald Groves, MD · Answer

Unfortunately, it is difficult to answer your questions without having a formal discussion with you of your specific goals and performing a formal physical exam. Let me help answer some of your questions and give you more information though..1. There are multiple treatments which can help tighten your skin without surgery- chemical peels, CO2 laser, microneedling, Morpheus, etc. A facelift or mini-facelift similarly help with skin tightening (by surgical removal of excess skin), but also allow for adjustments to some of the deeper face structures- e.g. tightening of the SMAS layer, simultaneous fat grafting to certain areas to fill deficits. Also, if you have prominent jowling, significant neck skin laxity, or banding in your neck, these are best addressed with some type of facelift instead of a noninvasive treatment like Morpheus. Usually facelifts are done on patients older than you though.2. Dermal fillers and fat grafting can both add volume to specific areas of your face. Fat grafting does this by taking the fat from your abdomen or thighs, and injecting it into your face- this is a procedure/surgery though. The fat injected is your body's own natural tissue, so you don't have to worry about rejection or reactions to the injected material. Once the fat "takes" (lives and integrates into the new injected site), the results last a long time. Dermal fillers are usually hyaluronic acid (HA) and you pay per vial. They do not require surgery, and are injected in the office setting. They typically degrade over a 12 month period, so you should plan to have them re-injected every year or two based on how things look. .With all that said, there is limited information that can be gained from the 2 photos you have provided. Based on your age, I would say you should be able to avoid surgery for now- so my tentative recommendation would be a skin tightening treatment plus dermal filler if needed (e.g. to the tear troughs). I would however, urge you to arrange a consultation at a medspa initially, and if they feel it is indicated, with one/multiple plastic surgeons to really make sure your specific goals are properly met. I hope this helps! .Best, Dr. Donald Groves Plastic Surgeon

Lisa Brostrom, MD · Answer

Hello, and thank you for your question. Often patients develop volume deficiency in the region of the tear trough and upper cheek with weight loss. You may benefit from a lower eyelid blepharoplasty with fat grafting to the tear trough, orbital rim, and cheek area. This should help smooth the lid cheek transition. Laser resurfacing with fractional CO2 will also help.Jowling is difficult to evaluate from the pictures you submitted. If you feel that you have laxity over the lower face you would likely benefit from fractional CO2 and radiofrequency microneedling to increase collagen, thicken, and tighten your skin. A Board Certified Plastic Surgeon can evaluate you in person and find the best options to meet your goals. Good Luck!

Connie Hiers, MD, FACS · Answer

Yes, you are too young for a facelift. However, you could consider noninvasive micro-needling with radiofrequency like Secret to help tone and tighten what might be somewhat loose and help maintain what you have as you age.

Mark Eberbach, MD · Answer

Good morning.

Based on the isolated photographs, it appears that you do not have Joelyn. What you may have is prominent buccal fat. This buccal fat pad on each side, can fairly easily be removed from an inside the mouth approach to give you a more lean appearance in this area.

Good luck.

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