Severe jowl on one side of my face and a deflated cheek (Photo)

Question

I'm in my early 20's, light smoker of 4 years(recently trying to quit) years ago I noticed an asymmetry in my jaw, the right muscle is more developed, jowls run in my family but my left jowl has always been larger and over time has become distinctly larger than the right. I have to different profiles, the left in most light has a pronounced slit from the corner of my mouth to my jaw. I know everyone has asymmetry but I'd like to know if there is any way to tighten the skin on the left side

Nelson Lee Novick, MD · Answer

The photos provided do seem to indicate a rather marked asymmetry between the left cheek and the right. The depression on the left side can be corrected with the use of a volumizing filler for "deep support volumetry." . My choices for this in my Upper East Side Manhattan practice would be a combination of Radiesse and Voluma XC. (In my Israel satellite facility where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt for Emervel Volume and Stylage XXL for this problem). The mid-face volumization, by providing the necessary lift, would very likely secondarily improve the marionette line region below it on the left side, as well. If additional treatment is still necessary to improve any residual fold still further, I would do so with Perlane L (in New York) and Restylane SQ (in Israel).Be sure to seek consultation with a board certified aesthetic physician with experience and expertise in panfacial rejuvenation techniques for restoring volume, balance and symmetry. Make sure to ask to see his/her before and after photos.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

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.

Severe jowl on one side of my face and a deflated cheek (Photo)

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