29 year old, is asymmetry & sagging lower face fixable with facelift? (Photos)

Question

I am 29 yo female, I’ve always had this asymmetry but now is more noticeable and my lower face looks saggy. Can this be fixed/improved with a lower face lift? Should I consider jaw surgery? as well? Are there doctors in the US that could help me? I consulted doctors in South Korea, but would prefer to stay local in case of complications/follow ups.

Donald Groves, MD · Answer

Hello and thank you for your question. From what I can tell based on the pictures you have provided, you have a well defined jawline and no significant jowling. You do not have excess neck skin, visible plastysmal banding in your neck, or lower face/neck wrinkles. The only thing I can see is prominent tear troughs, much more noticeable on the right than the left. Based on all that and on your age, I would recommend only soft tissue enhancement to soften the lower eyelid/cheek junction, and potentially also augment the upper cheeks (if you desire). You can use this to correct asymmetries and improve facial harmony and refine the face shape to give a more youthful appearance. You should definitely hold off on something as invasive as a facelift for now, as it would not really provide any noticeable benefit at this time. 
When it comes to soft tissue enhancement, the main options I recommend are dermal fillers or fat grafting. Fat grafting adds volume to specific areas of your face by taking the fat from your abdomen or thighs, and injecting it into your face. This 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. This differs from hyaluronic acid (HA) filler, the most common type of dermal filler, which typically degrades over about a 12 month period, meaning you need periodic re-injections to maintain the results.
It is very difficult to provide tentative surgical recommendations, especially since there is only so much information to be gained from the limited photos which you have provided. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps! 
Best wishes, 
Dr. Donald Groves 
Plastic Surgeon

Gianfranco Frojo, MD · Answer

I believe that you would be a fantastic candidate for a facelift and necklift. It might be too early but it would certainly address your concerns.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. While you don’t appear to be a surgical candidate, you may enjoy the benefits of a liquid facelift to improve symmetry and enhance your natural beauty. While perfect symmetry is impossible to attain, liquid facelifts use a combination of dermal fillers and neuromodulators to fill and lift the face and balance the facial features. The most natural results are achieved by targeting the specific fat pockets that have lost volume, so an in-person consultation with an experienced, expert injector is recommended. They will be able to discuss your concerns with you and suggest the best procedure to help you achieve your aesthetic goals.

Ajaya Kashyap, MD · Answer

Thank-you for your query. Based on the photographs and your age, you are not a candidate for a surgical facelift. Jaw surgery may  also not be appropriate for addressing your concerns.  A non surgical facelift based on ultrasound (HIFU) or radio frequency (ThermiTight or Facetite ) coupled with some soft tissue sculpting and augmentation may help you achieve your goals. Please find a Board certified Plastic surgeon near you who can address all your concerns and hep you make a decision. All the best!

Suleyman Tas, MD, FEBOPRAS · Answer

Dear Dianarg, 
Thankyou for your attaching pictures for reference. It seems you are experiencing face laxity where the skin is losing its firmness and tightness especially in the mid face area. If you are looking for a permanent solution I would recommend a mid-face lift combined with Lower blepharoplasty, the lift will eliminate the sagging cheeks/nasolabial folds and the lower blepharoplasty will remove the excess skin under the eyes and prevent your skin to collect under the eyes when smiling. Furthermore, I would also suggest you to get fat injections for your deep smile lines to fill in the lack of volume. For the midface lift and lower blepharoplasty i would strongly suggest to find a expert surgeon who does endoscopic scarlesss lift and follows the vertical lift technique in order to get a much natural lifted look. 
Best Regards,
 TAS TEAM

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. You are 29, you do not need a facelift. That being said, I am sure there are surgeons out there who would offer you one and I am not saying it is wrong, I just think that at your age there are much less invasive procedures that can offer great outcomes. Depending on your specific areas of concern and indications, you may be best treated with laser resurfacing, Morpheus8, Botox, fillers, buccal fat pad removal, FaceTite, etc. The list of options is long so make sure you see a plastic surgeon who is board certified by the American Board of Plastic Surgery.
Good luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Jeffrey H. Spiegel, MD · Answer

Hello - yes, there are many ways to adjust your face.  You do have some asymmetry which may be bone, soft tissue, or a combination.  The treatment will depend upon what is the key component.  We do a lot of surgery for this problem at my office. For you, I would anticipate contouring the soft tissue and doing some volume adjustment with chin reshaping as you have something of a hanging chin. But, an in person consultation will tell us much more. Watch our videos to learn more.

Cagil Meric Erenoglu, MD · Answer

Hi, Dianarg! Thank you for your question and photos. 
A lower face lift will leave scars, which are more prominent in young patients. An alternative treatment is the endoscopic mid-face lift with or without temple and brow-tail lifting. This procedure will lift the lower face as well and will help with the grooves under eyes. Fat-injection will also help with the asymmetry correction.

Scott C. Lindsay, DO · Answer

Thanks for your question! I think a facelift at this point would be too much. Something like FaceTite, which is minimally invasive, could provide a subtle improvement. I would suggest consulting with a qualifying physician. Good luck!

Dean P. Kane, MD, FACS · Answer

Dear Exuberant5681, 
Thanks for sharing your photos.  I see the mild asymmetry and lower cheek laxity you note concern over. The asymmetry is associated with the fusion of the bones while your cranial skeleton was forming your mothers uterus. The skin hangs from the bones and soft-tissues. You can see this asymmetry under your eyes along the cheek bones. Skin and underlying fat laxity, cheek sagging, folds and wrinkles occurs with facial aging from collagen loss. There are many ways to improve your concerns but it takes a in-person evaluation from an experienced, Board Certified Plastic Surgeon skilled in non-surgical, minimally invasive and surgical options to achieve your goals. Consider: 
•	Minimally invasive filler options to achieve better balance and symmetry along the anterior, middle and lateral cheek bones. 
•	Mini-lipo-contouring of the lower cheek / jowl and jawline will reduce the fullness there and the fat can be grafted instead of using fillers. You may wish to consider PDO thread lifting to elevate and contour the face as well. 
•	I would also recommend beginning a life-long skin tightening regimen using tretinoin  from a Certified Zein Obagi, ZO Skin Health team. 
o	Later considerations to maintain tightening are Sculptra and TCA skin peels. 
•	Facelifting is more than required to achieve your desires. 
I agree with your South Korean Plastic Surgeon. If you find a experienced and skilled PS there, local is better considering follow-ups, expectations and complications. 
I hope this helps. All the best!

29 year old, is asymmetry & sagging lower face fixable with facelift? (Photos)

Answers (12)

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