What procedure or treatment would be most effective for addressing my sagging cheeks? (Photo)

Question

I’m a 31-year-old female who has spent a significant amount of time driving with unprotected sun exposure, mostly on the left side of my face through the window. My upper and lower left cheek is visibly more saggy and deflated looking than the right side, which remains a bit fuller. I’ve been wearing daily sunscreen for about 3 years now since discovering how important it is to prevent skin aging. I’m wondering what treatments or procedures would most effectively address these issues. Thanks!

Alan Gonzalez, MD, FACS · Answer

Greetings @kslaw55, thanks for your question and showing your pictures! A mini facelift can help to lift and tighten sagging skin on the face, typically targeting the lower half of the face and neck. While mini facelifts are often used to correct signs of aging such as jowls, wrinkles, and sagging skin, they are not typically recommended If skin looks youthful. It is very possible to improve the skin elasticity and define the edges of the face or mandibular line with a nonsurgical treatment like Ultherapy. This may be a non-surgical alternative. It is important to consult one or several board certified plastic surgeon for more information and recommendations. Best wishes!

Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Bora Ok, MD · Answer

Hi from Istanbul, thanks for this question. A mini facelift is effective for patients like you, who have sagging in the jowl area without significant neck sagging. This procedure involves an incision in front of the ear to lift the SMAS tissue, reducing the sagging and providing long-lasting results. I recommend this approach.

If you prefer not to have a facelift, you can benefit from mild liposuction in the jowl area combined with the application of a hemostatic surgical net.

The surgical net procedure involves inserting a small needle into the sagging area, releasing the skin underneath, lifting the skin, and securing it with stitches that are removed after two days. This technique causes skin contraction and can be a good alternative if you prefer not to undergo surgery. Hope this helps, best of luck to you!

John Michael Thomassen, MD · Answer

A mini facelift will correct the cheek ptosis and jowl fullness you see on the sides of your mouth.  This can be done with a short scar so that scarring is minimal.

Lucian Ion, FRCS · Answer

Thank you for your enquiry and sharing your photographs.
My impression is that the you do not need to blame yourself for not wearing the sunblock. This is not to underestimate the importance of sun protection, I am a true  believer in its value and recommend it wholeheartedly to everyone who cares to listen! 
I get the impression that the underlying problem is predominantly the moderate crossbite and the fact that the chin is sitting slightly more towards the left. This creates a more concave appearance of the left side of the face and a more convex appearance on the right. This may have become more noticeable due to facial volume loss and slight reduction in the elasticity of the skin.
There is slight laxity and fullness along the jawline which could be improved with liposuction.
I would also suggest discussing with a maxillofacial surgeon whether a centralising genioplasty would be a reasonable intervention in your case.
Volume augmentation using injectable fillers or fat transfer can be used but should be in my opinion moderate to to create the best results.
Minimal access facelift surgery is the type of intervention that lifts the facial soft tissue volumes through an access in the sideburn and can be combined with fat transfer to produce a different balance of the facial features.

Michelle Copeland, MD, DMD · Answer

Thank you for your question! You might be a candidate for a non-invasive procedure called Thermage that can tighten skin and stimulate your body to make healthier collagen—the building block that provides structure to your skin. The procedure uses radiofrequency technology called ThermaCool® that has been clinically proven to tighten and lift skin. Fast and easy, Thermage requires no downtime from normal activities. A combination of Thermage and non-ablative lasers can be a powerful nonsurgical treatment to help tighten and smooth skin all over the body. My office also has an innovative skin treatment which uses a combination of microdermabrasion and various laser treatments to help improve skin quality and appearance. I have also created skincare products that scientifically help improve quality of your skin. I suggest making an appointment with a board-certified plastic surgeon to discuss your options in more detail!

J. Renee Booth, MD · Answer

This is considered mild cheek laxity and is not related to sun exposure. Causes currently thought to contribute to this include gravity, gradual loss of bone over time, and genetics. A treatment that has shown great results in many people is a series of radiofrequency microneedling such as Profound RF. Usually people get 3 sessions. Some people decide to get a midface lift which gives nice results, however it requires more downtime.

Mats Hagstrom, MD (license on probation) · Answer

You are 100% correct about sunscreen and protecting yourself from sun damage to prevent premature aging.
Whenever I see Caucasian women in their 40s who have no wrinkles I asked them what age they began wearing sunscreen and inevitably they tell me “since I was born”. sunscreen and avoiding excessive. Sun exposure is the only way to slow down facial aging.
It is magical in comparison to treatments once facial aging, and sun damage has taken its toll.
In your case, the hanging face is not related to Sun exposure, but it is directly related to the size of your mandible, which is small and is lacking support for your midface. it is not an easy condition to treat, and the application of soft tissue solutions to treat facial skeletal problems. Will give partial solutions at best.You can consult with plastic surgeons in your community to see what they have to say.
I anticipate you’ll get responses like Liposuction or a facelift, though again recognize that those are soft tissues solutions For a facial, skeletal problem.
You can certainly consult with oral surgeons and get an assessment and understanding of all treatments available.
Best,
Mats Hagstrom, MD

Olatomide (Tomi) Familusi, MD - Account Suspended · Answer

Sun protection is essential to delaying certain signs of aging such as fine lines and wrinkles. However the sagging, early jowl formation and loss of jawline definition that you have are not necessarily related to sun exposure but more a result of deflation and descent of the fat pads in your cheek related to gravity and volume loss. Dermal fillers are a good option to restore volume in the cheek and can help camouflage jowls along the jawline. The can last 1-2 years and are non invasive so come with very little down time. A mini facelift is good option for patients who dont have a lot of skin laxity that would typically be addressed in a standard facelift. The mini facelift focuses on resuspending and lifting the tissues that have been pulled down by gravity restoring a crisp jawline and midface fullness. This can be combined with fat transfer further restore a youthful midface by treating the hollowness that is noticeable in your photos.