Face has changed a lot in the last 1-2 years. Could this be due to volume loss or is it festoons? (photos)

Question

I’m noticing my face changing a lot in the last year or so. I’ve noticedloss of volume in my test trough. I’ve always had thin skin under my eyes, but it is now affecting my smilingprofile . I’m noticing more wrinkles under my eyes when I smile. I got severe dry eye a few months ago. I often wake up w puffy cheeks. I’ve gained ~10 healthy lbs + been lifting, so the fat in my cheeks has settled differently. Since my nasolabial lines are changing a bit, could this be festoons instead?

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

At least from the photos provided, early tear trough development is present. I see no evidence of festoons. If this is indeed the case, the appropriate use of an appropriately robust filler to the upper cheek region (not directly into the tear trough) would likely improve this issue. The upper cheek region directly below the lower lid area is the a major support for the lower lids. When volume deficit or decent of the fat pad occurs in the upper cheeks, tear troughs develop. Restoring the volume with an appropriate filler can address this issue often without the need to directly treat the tear troughs themselves. You would be wise to consult with an experienced, board certified cosmetic dermatologist and be certain to ask to see his/her personal before and after photos before agreeing to proceed Best of luck.

Camille Cash, MD · Answer

Fillers are a great tool to replace volume in the face and improve facial contours.  It does not appear from the photos submitted that you have festoons.  I encourage you to meet with an experienced injector near you to discuss filler.

Face has changed a lot in the last 1-2 years. Could this be due to volume loss or is it festoons? (photos)

Answers (3)

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