Heavy “drooping” lower face in 20s. Options? I would like a more effective method than just fillers & Botox (Photo)

Question

Have tried botox, fillers and PDO threadlift to improve my lower face. None have achieved my desired “V” effect. 3rd photo: Lifting my face upward and back, EXACTLY how I’d like to look. Don't have a problem with square shaped face. The problem is amount of fat/muscle in lower face and placement. 4th photo: You can see how the droopyness contributes to oral commisures/marionettes. Have already tried filler in this area. 1st photo: Even in decent photo, lower face appears heavy. TIA!

Jason Emer, MD · Answer

A combination approach will give the most improvement. I recommend fillers for the lines themselves but also lifting around the mouth and cheeks to build underlying anatomical support. In our practice we combine sculptra with other fillers "layered" on top and lasers, rf treatments, J Plasma and peels to get the most conservative natural look. Please see a facial sculpting expert. Best, Dr. Emer

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  Over the pst 15 years, many of these facelifts have been minimally, invasive SMAS facelifts.  In some of the photos, your lower face doesn't appear to have jowls yet the last photo seems to contradict that.  In such cases, an in person examination and explanation of the degree of bowling required to be a suitable facelift candidate is in order.  It should also be noted that overall, your face is rectangularly-shaped with angularity in the cheek area. 
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Proper aesthetic shaping of the cheeks and face may require precise removal of excess fat with micro-liposuction.  This can not be effectively accomplished with skin treatments in my experience and humble opinion.
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Suspension threads have been generally dismissed as ineffective by experienced facelift surgeons in the US despite their popularity elsewhere around the world.  The  reasons thread lifts don't work or last is based on tissue physiology which is consistent and predictable.  It would be advisable for you to consult with a "facial shaping expert" which is defined as one that has contributed (published articles, books, advancements) to the field of facial aesthetics through shaping the face with the ability to perform the full spectrum of facial shaping procedures including: proper SMAS facelifts, placement of silastic facial implants (cheek implants, chin implants, lip implants), facial liposuction, precise facial shaping with dermal fillers (fat should not be used for facial shaping as it remains an unreliable source as discussed below) as well as skin resurfacing. I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

Heavy “drooping” lower face in 20s. Options? I would like a more effective method than just fillers & Botox (Photo)

Answers (2)

Recommended reading

Everything you need to know about Lower Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.

Heavy “drooping” lower face in 20s. Options? I would like a more effective method than just fillers & Botox (Photo)

Answers (2)

Browse related questions

Recommended reading

Everything you need to know about Lower Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.