Post weight loss drooping and unevenness - What do you recommend to rejuvenate? (Photos)

Question

37yo and wanting a refresher-—lost a fair amount of weight it seemed to cause a drop in my face. Im also noticing a fair amount of uneveness.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Enthusiastic758644,

Thank you for your question. Weight loss can definitely change the face, and in younger patients it often shows up as loss of support, mild drooping, and more visible asymmetry.

Based on your photos, I do see some mild descent and volume change, especially through the midface and lower face. That does not necessarily mean you need a facelift. At 37, the better approach is often to first decide how much of this is volume loss versus true tissue laxity.

In many cases after weight loss, a conservative amount of volume restoration can be very helpful. That may mean filler or fat grafting, depending on the area and your goals. If there is mild soft tissue descent, some patients may benefit from a lifting procedure, but I would usually be cautious about recommending a formal facelift this early unless the exam clearly supports it.

As for unevenness, perfect symmetry is not realistic in any face, but weight loss can make natural asymmetries easier to see. The key is identifying whether the difference is coming from volume loss, facial muscle balance, or soft tissue position.

So overall, I would think first in terms of restoring balance and support rather than doing a large surgical procedure right away. An in-person evaluation with a board-certified plastic surgeon would help determine whether the best plan is filler, fat grafting, a limited lifting procedure, or simply good skin maintenance and time if the weight loss was recent.

Warmest regards,

Dr. Stephenson

Kadir Berat Oyur, MD · Answer

Hi and thank you for your question.For post-weight loss facial drooping and unevenness, we recommend a facelift, which can lift sagging tissue, restore symmetry, and create a refreshed, balanced appearance.

Javier Parada, MD · Answer

Following weight loss, facial changes are often due to a combination of volume depletion, mild–moderate skin laxity, and loss of deep structural support, which can result in drooping and asymmetry.
If laxity is more structural or progressive, a surgical option such as an endoscopic facelift may be considered. This approach addresses deeper tissue descent with minimal incisions and is best suited for patients with good skin quality and early facial ptosis.

A.J. Amadi, MD · Answer

My name is Holly Frandsen and I'm an aesthetic Injector at Amadi Aesthetics Plastic Surgery. We have seen this a lot more recently with more and more patients losing weight. When we lose weight, our fat in our face deflates and causes us to have volume loss. I would suggest a number of treatments:

Sculptra: This can help restore our elastin and collagen production as well as restore volume loss. This is however, gradual over time so it's not an "instant" fix.

Dermal Filler: Filler gives you instant volume and there are many different types of filler depending on your goals. If you were to consider filler, I would suggest having it in the cheeks to restore volume and that will slightly lift everything up.

This also depends on how much you would want to spend. Some patients go the more conservative route versus surgical.

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photographs. More significant weight loss can lead to laxity of the facial soft tissues and is often associated with a degree of volume loss in the midface. The neck contours may also be affected in such circumstances; however, this does not appear to be the case for you.

Overall, my impression is that a combination of a deep plane facelift and fat transfer to the midface would be likely to produce a favourable balancing effect on the facial volumes and contours. This approach allows redistribution of volume from the lower face towards the midface, with further enhancement achieved through fat transfer. It is also quite likely that this combination would help create a smoother transition between the lower eyelids and the anterior aspect of the cheek, resulting in a more harmonious and refreshed appearance.

John Diaz, MD · Answer

After weight loss, drooping and facial unevenness are very common and are usually caused by loss of volume combined with tissue descent. In these cases, I often recommend a facelift, frequently using an endoscopic-assisted approach, to reposition the deeper facial structures and restore balance to the face.
For patients who are younger or have mild to moderate laxity, an endoscopic facelift allows me to lift and support the tissues in a natural direction through small, discreet incisions. Depending on the degree of volume loss or asymmetry, I may also combine the facelift with fat grafting or other complementary procedures to improve overall harmony.
The best treatment plan depends on your anatomy and goals, so an in-person consultation is essential to determine the most effective and natural-looking approach.

Oliver Chang, MD · Answer

Based off your photos - as you stated there is notable midface volume loss, tear troughs, mild jowling and asymmetry. The asymmetry will always be there, very hard to correct especially when anatomically we are built asymmetrical from the bone up (so correcting asymmetry usually isn't doable, making improvements to being closer is.) 
Fat grafting to the face with nanofat superficially, microfat deeper are powerful ways to rejuvenate especially for someone who is young and does not necessarily need any cutting procedure yet. An endoscopic midface lift could be another option. There are many things that can be added - c02 laser to the tear trough area in conjunction with lower bleph fat transposition. 
Or you can try fillers to see if the augmentation will be to your liking and if it is, convert to a more permanent solution with fat grafting. Seek out a few surgeons to see your options.

Vipul Gargya, MD · Answer

I truly think fat transfer to the face will do wonders for you. It is one of the most effective ways to restore softness, balance, and youthful volume after weight loss, and it complements other rejuvenation treatments in a very natural, refreshed way.
The key is choosing a board-certified plastic surgeon who specializes in facial fat transfer. Fat transfer to the face is technically demanding, from atraumatic harvest and processing to precise placement in the correct facial planes. When done well, it produces consistent, elegant results; when done poorly, outcomes can be unpredictable. Surgeon experience makes a significant difference here.

Franklin D. Richards, MD · Answer

From your photos I can see the dropping that you mention. There is no better way to provide predictable long lasting results than with surgical tightening. Though you are young, we are seeing younger and younger patients who are good candidates for facelift or mini-facelift due to significant weight loss. There is no defined age to get lifting procedures done. I usually tell my patients that when the facial laxity is at a point that it really bothers you, then that is the time.

Gary M. Horndeski, MD · Answer

You have facial asymmetry and would benefit from a rhinoplasty to straighten the nose and correct the uneven nostrils. You would 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.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Post weight loss drooping and unevenness - What do you recommend to rejuvenate? (Photos)

Answers (12)

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