What do I need to balance my face? I’m open to Botox, implants, liposuction. Pretty much everything except fillers. (Photos)

You are right on spot with the lines drawed on your photos, and also about tagging your problem as non diet related, correct.

You have microgenia, this means underdeveloped chin; systematically every and each patient with such imbalance between the osseous structure and the overlying soft tissues, they do show some degree of sagginess and droopiness at jowls, upper neck, marionette lines and angles of the mouth, even at early ages; evidently this can be aggravated by weight gain-loss cycles.

This is straightforwardly treated by an augmentation genioplasty with addition of bone grafting, not just a sliding genioplasty in cases of pure microgenia like yours.

See below before and afters to understand and check how every chin agumentation enjoys a kind of "free of charge lower fac and upper neck lifting".

Hello,
Thank you for you question.
At 21 and 110 lbs, persistent facial fullness—especially around the mouth with flatness under the cheekbones—is often due to inherited facial fat distribution rather than weight. For a more defined jawline and natural contour without fillers, a combination of buccal fat removal to slim the mid-cheek, masseter Botox to reduce lower facial width if muscle bulk is present, and cheek implants or fat grafting to enhance volume under the cheekbones may provide the balanced structure you're seeking. If jawline definition remains limited, chin or jaw implants and/or submental liposuction could further refine the look.

The photos show that you have a recessed chin and this makes your face look wider and shorter. I would recommend a chin implant or sliding genioplasty to improve the balance of your lower face. This will give you a more slender appearance. If greater than 5 mm of horizontal projection is needed, I would recommend a sliding genioplasty over an implant. Both procedures are performed in the office with sedation anesthesia.

You would benefit from a chin implant. This will also tighten up the skin of the neck. You may also benefit from an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. Another thing to consider is a rhinoplasty. The tip of the nose is somewhat asymmetrical and bulbous.

Best Wishes,

Gary Horndeski, M.D.