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

Question

I was an extremely overweight child and teen, bu I healthy and very petite (about 48kg) for a decade now. I constantly get comments about looking sad or angry and really am becoming self conscious about how heavy and undefined my midface looks. What are my options? The muscle and fat are slack in my opinion so I was wondering would a midface lift of some sort be an option in a few years!

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

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

John Mesa, MD · Answer

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)

Stephen H. Fink, DO, FAOCO · Answer

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

Pejman Aflaki, MD · Answer

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

Michael I. Echavez, MD · Answer

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.

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

Answers (10)

Answer: Facial rejuvenation

Answer: Facial rejuvenation

Answer: Options for facial volume loss

Answer: Options for facial volume loss

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

Answers (10)

Answer: Facial rejuvenation

Answer: Facial rejuvenation

Answer: Options for facial volume loss

Answer: Options for facial volume loss

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Recommended reading

Everything you need to know about Facelift

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