What can be done to treat my jowls, under eye creases and asymmetry? (Photo)

Question

I am 27 years old and my face is sagging significantly. I have developed jowls and deep under eye creases. My face is very asymmetrical and lacks definition. I would like a “snatched” youthful appearance. I am ashamed of how badly I am aging. I do not drink or smoke, I eat healthy and get exercise. I take very good care of my skin.

Timothy M. Rankin, MD, FACS · Answer

You may be a good candidate for a facelift or a lower eyelid lift. You should have noticeable signs of aging, such as sagging jowls, skin laxity, or wrinkles. While some signs of aging can be addressed without having surgery, a facelift can help correct them long-term. The word “facelift” can make some people nervous, however the procedure involves lifting and tightening the skin and repositioning the underlying fat and muscle. Dr. Rankin will examine your face’s structure during your consultation to determine which procedure is right for you.

Arif Eroglu, MD · Answer

Hello; Facial asymmetry; it may originate from soft tissue or bone. In order to determine this; A 3D CT scan is required. Asymmetry; that is caused by soft tissue; it can be fixed with fillings or prostheses. However, in bone-related asymmetries; it is necessary to intervene within the bone. As for your face; if you have lost weight; accordingly, your face will become loose or loses for volume. When take a look for your photos; shortness in both your chin and loss of volume in your malar area; there appears to be a collapse in both your lower orbital area. For the shortness of your chin; Hydroxyapatite or Hyaluronic acid filling can be implemented. Autologous microfat fat transfer; conceivable. Likewise, for elevating your malar area and cheeks; Hydroxyapatite or Hyaluronic acid filler can be used as well. Autologous microfat fat transfer; can be done. In the zygomatic bones, if there is no asymmetry; a prosthesis is also placed in that area; can be upgraded. For the hollow in custody; autologous microfat fat transfer or hyaluronic acid based filler can be applied.

Ryan Rebowe, MD · Answer

The main things that you are noticing are likely due to the lack of bony support in key areas of your face. The first thing would be a chin that is set back, which could be augmented with an implant or sliding genioplasty. Secondly, your cheeks of a "negative vector" compared to your eyes, meaning they are slightly set back. Although cheek implants have largely fallen out of favor, this can typically be augmented with fat grafts or filer. These would be the foundational things to correct before pursuing other surgical procedures.

Ramin Behmand, MD, FACS · Answer

Jowls form from the sagging of facial skin, muscles, and deeper tissues along the lower jawline and chin area. You are very young, with tight facial skin, and do not have jowls. However, I can see the changes that are bothering you compared to your 2020 photograph. From the front view, there is some loss of soft tissue between the chin and the cheek area along the jawline. Additionally, your chin is slightly recessed in profile, which doesn't help with these soft tissue changes.

You have two options:

1. Non-surgical: Fillers in the pre-jowl area and the central chin area. This is a temporary fix that will need to be repeated.
   
2. Surgical: A chin implant or sliding genioplasty (moving the chin bone forward), plus micro-fat grafting into the pre-jowl area. This is the preferred option.

Dr. B.

Gary M. Horndeski, MD · Answer

A lower blepharoplasty can be done to treat the eye creases. You would also benefit from a lip lift. A lip lift 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. You would also benefit from a chin implant. This will help the recessed chin and tighten the skin.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Mats Hagstrom, MD (license on probation) · Answer

I think the primary issue is your mandible which is small and lacking in projection. This leaves your face without a sufficient foundation to support your soft tissues. 
If you look at those who maintain a strong jawline into middle age they then to have a strong mandible. Look at Carmen DelOrafice or George Clooney for example. 
Soft tissue solutions may leave you disappointed. 
At the same time growing a bigger mandible is not so easy either. 
I suggest consulting with both Plasic Surgeons and Oral Surgeons to get input from both specialties.
Expect to get differing opinions. Simple treatments may not do much for you. 
Avoid sun damage. Always use sun screen and avoid extensive facial sun exposure.
Mats Hagstrom MD

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