Age 28. What are my options for loss of volume, sagging, marionettes and a sad mouth? (Photo)

Thank you for your question and pictures.  You do not have loose skin for surgery, therefore nonsurgical options such as injectables like filler to soften your marionette lines.  You could try and achieve an upturn for your lip by using lip filler, or a lip lift would be the best permanent solution.  Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.  All The Best 

Sagging and volume loss of the face at early years (eg 20s) is usually related to weak cheek bones.Cheek bones are the foundation of a youthful ("lifted") facial appearance. When the cheek bones are weak, the midface tends to sag, corners or the mouth tend to go south and marionette lines starts to form. Augmenting the cheek bones could reverse the signs of aging. Cheek bones can be easily augmented in the office setting with soft tissue fillers like voluma or surgically with implants (medpore implants)

Thank. you for your question and photos. Most of the time, reversible noninvasive treatments are best for early aging in our twenties.  Healthy nutrition and good skincare followed by non invasive skin tightening procedures like Ultherapy and radio frequency micro-needling could be considered.  Your skin should respond well to these modalities by tightening and  producing collagen. Further lifting and supporting of tissues can be accomplished with a conservative combination of Botox and HA Fillers. An in person evaluation to assess the extent of true skin laxity is also recommended. 
Best,
Dr. Stephen Fink

I would start with a
good skin care and non-invasive facial rejuvenation methods, including Botox
for upper face rejuvenation to treat horizontal forehead lines, vertical
glabellar line and crows feet. Fillers would address the volume loss for malar
augmentation and improving the nasolabial and marionette lines. I would
consult with a plastic surgeon and discuss your specific concerns.
Pej Aflaki, M.D.

Johns Hopkins-trained
plastic surgeon

I would not recommend any surgery for you at this point, but injectable fillers could be used to add volume and could provide a bit of a lift.  

Congratulations on your weight loss.  Your facial deflation can be help some with filler agents placed in your midface to enhance your cheek bones,however these are temporary.  As you are 28 years old and your skin still likely has good elasticity, a mini-facelift should improve your cheek contour, smooth your jawline, slightly lift the cornersof your mouth and sharpen the contour of your neck.   Recovery from a mini-facelift is approximately 1 week and should help you gain a better defined facial contour.   Always see a board certified plastic surgeon.  Best wishes.

Fillers would probably be a great option for you rather than having any type of surgery at your age.

Congratulations on your weight loss. Often times with weight loss, one will get volume loss in the mid face / cheek area. There are many fillers that do an excellent job of adding volume creating a more youthful appearance.  Voluma XC would be a great choice. I would begin with fillers before having surgical intervention. Consult a board certified facial plastic surgeon in your area.  

Hello NiftyPineapple914,Thank you for adding photos and congratulations on the weight loss!In looking at your photos, I see a few things that may be helpful before you consider having surgery. I don't think that you have a big enough problem with extra muscle/skin/fat to undergo surgery at this time. Part of your concern may be related to a relative lack of bony volume in the cheeks (small cheekbones). You can see this most clearly in the photo of the right half of your face from the side. You can also notice the beginning of a tear trough (the line that starts in your cheek and goes to the inside corner of your eye)This can be improved without surgery through the use of filler. I would suggest starting with that to help balance your face before going any further. Hope this helps!dr. silver

 Hi, I have performed many facial shaping procedures and SMAS facelifts for over 30 years.  Many of these have performed many minimally, invasive SMAS facelifts on women in their late twenties and early thirties that had premature formation of "jowls".  From the photos the cheeks are very flat in the front, there is some excess fat in front of the cheeks (more so on one side) and the chin is weak with some chin ptosis (sagging muscle) and excess skin under the chin.  There is however, no evidence of "jowls" in the lower face and for this reason, no type of facelift seems warranted (described below).  These factors combine to create a rectangular shaped face. 
 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 to the sides of the cheeks to soften the angularity combined with liposuction of the excess fat in front of the cheeks will create full, round cheeks that can feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and the primary indication for some form of a SMAS facelift.  In any form of effective 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 anesthesiano incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-opI 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.
Hope this helps.