What procedures are recommended to reduce laugh lines, cheek fullness and sharpen jaw? (photos)

Question

I’m a 25 yr old female. All my life I’ve been struggling with a full face and laugh lines that make my side profile weird. I’m hoping to get some advice on procedures I should look into to achieve the look I want. Mainly it is to reduce laugh lines and the cheek bulging/slim the face in the mid and lower face (near lip corners) as well as sharpen side jaw and reduce underchin bulge. Any recommendations will be much appreciated thank you.

George Yang, MD · Answer

Hi, the fullness of your lower face around the mouth and below the lip area is the pouch between your teeth and inside of the mouth. You can’t really flatten that out by defatting that area. if you lose the fullness that you currently have will be replaced with marionette lines and sagging of the lower face. You have naturally full lips, but your chin fullness (bone and fat) does not allow it to blend smoothly to the fullness of the lower face. This makes the lower cheek appear too full, but actually the lower cheek is normal. If you look at faces that you admire appearance-wise, from their lower lip to their chin there isn’t much of a shadow and their chin has some fullness and creates a wide shadowless border around their mouth and lips. By having less shadowing around the lips it highlights the features on our face which is our eyes, nose, and lips. If there is fat loss or dark circles around the eyes, it takes away from the “feature in this case the eyes.” As people get older (25 is pretty young), we get smile lines, which creates a shadow by the side of the nose and takes away attention to the nose as a feature. The faces we admire also have a pouch where food goes, but you cannot see the fullness, because their chin and jawline have enough volume to blend with the lower cheek. I hope this answer provided some value to you. Good luck with your research. Best, Dr. Yang

James M. Economides, MD, FACS · Answer

Based on your goals to reduce laugh lines, slim your mid and lower face, sharpen your jawline, and reduce the underchin bulge, there are a variety of both non-surgical and surgical procedures that could help you achieve the look you want. Here’s an overview of some effective options:

1. Laugh Line (Nasolabial Fold) Reduction:
Dermal Fillers: Fillers, like hyaluronic acid (e.g., Restylane, Juvederm), are commonly used to soften laugh lines by filling in the creases. A small amount of filler can provide natural-looking results.
Skin Tightening Treatments: Non-invasive treatments like radiofrequency (RF) microneedling or laser resurfacing can tighten the skin and reduce the appearance of laugh lines by stimulating collagen production.
2. Cheek Bulging and Slimming the Mid and Lower Face:
Buccal Fat Removal: If you feel that the fullness in your cheeks is due to excess fat, buccal fat pad removal can help slim the midface and create a more defined contour. This procedure involves removing the fat pads in the cheeks to reduce fullness.
Botox for Masseter Muscles: If your jaw appears wide due to overactive masseter muscles (the chewing muscles), Botox injections can slim the lower face and jawline, resulting in a more tapered look. This can also help with reducing the prominence of the cheeks near the lip corners.
Chin and Jawline Contouring Fillers: Dermal fillers can be used to sharpen the jawline and chin, giving a more sculpted appearance. Hyaluronic acid fillers, like Juvederm Volux, are commonly used for jawline definition.
3. Underchin Bulge Reduction:
Kybella: This injectable treatment is specifically designed to reduce submental fat (under the chin) by dissolving the fat cells. Multiple treatments may be needed for optimal results.
Liposuction: If you have more significant underchin fullness, submental liposuction may be a better option for targeted fat removal. This is a minimally invasive procedure that can provide more dramatic and permanent results.
Ultherapy or RF Skin Tightening: These non-invasive treatments use ultrasound or radiofrequency energy to tighten the skin under the chin, which can also help reduce the appearance of fullness.
4. General Slimming and Contouring:
Non-Surgical Face Slimming: Treatments like Ultherapy (ultrasound-based skin tightening) or Thermage (radiofrequency skin tightening) can help lift and firm the skin, providing a more contoured look to the mid and lower face.
Fat Transfer: If you want more long-term results, fat transfer can also be used to sculpt the jawline and reduce fat in unwanted areas. This technique harvests fat from one part of your body and uses it to sculpt areas like the chin and jawline.
Final Recommendations:
Consult with a Plastic Surgeon or Dermatologist: Since each person’s facial structure is unique, it’s important to have a consultation to discuss the best options for your specific facial anatomy. A combination approach may work best for you, such as addressing both volume reduction and contouring.
Non-Surgical vs. Surgical: If you’re looking for less invasive options, start with treatments like Botox, fillers, and non-invasive skin tightening. For more dramatic results, procedures like buccal fat removal or submental liposuction can provide longer-lasting changes.
By combining the right procedures, you can achieve a slimmer, more contoured face with a sharper jawline while reducing the appearance of laugh lines.

Jason Emer, MD · Answer

I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer.

Sheryl D. Clark, MD, FAAD · Answer

Hello kn7402:
I understand completely the concerns you express. You are a lovely, healthy young woman with beautiful eyes and mouth, but some minor imbalances in proportions that is leading to the issues you have noticed. Some of us are born with facial features or musculature that can exaggerate sagging, such as a weak chin or overactive mouth muscles. In your case, fillers placed strategically in specific areas of the chin and jawline and just under the junction of the chin with the neck, and a tiny amount of neuromodulators, perhaps 6 to 8 units,  will drape the tissues of your cheeks and jawline in such a way that your face will look and feel more balanced, you will see less sagging around the mouth, and your neck and jawline will be more defined. By removing the distraction of a chin that is a bit recessed, you will allow the lips to be framed more harmoniously and reveal their intrinsic beauty to the observer. 
Fillers can be chosen to meet the duration you desire and according to your budget, and treatment can take place in one or two sessions within a few weeks or be spread out over several months, as you desire. 
I do hope this gives you some good for thought, and am happy to answer any additional questions you might have.
All the best from NYC, Sheryl Clark MD FAAD

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