Facelift Disproportionately Fat Face?

I have what I'd consider a very disproportionately fat face. I'm only 33 and thin yet the corners of my mouth are always turned down along with "marionette" lines. And my lower face is heavy. I have the puffy swollen cheek look of someone who just had dental surgery. When I pull the lower cheek skin back toward my ear it looks so much better. I know it's impossible to know for certain without a picture, but am I describing something that requires a Facelift to fix?

Doctor Answers 22

Facial Contouring or Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Though you are "young for a Facelift," it is only in the sense that we think of Facelift as an operation to improve aging changes.

With the many techniques for facial contouring that have evolved into routine "tools" for plastic surgeons, there is a great likelihood you can achieve the improvements you seek.  In my own practice, I have had young patients for whom facial contouring procedures proved very gratifying.

Without careful examination, it isn't possible to be specific about which specific techniques might best provide you with the improvements you desire.  Possibilities include some form of fat removal, like lipolysis, liposuction or buccal fat excision, perhaps in concert with a form of tissue lifting or redraping.

Seek consultation with a plastic surgeon well experienced in reconstructive and cosmetic surgery of the face.

Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

Facelift for a Disproportionate "Fat Face"

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is usually not appropriate to do a facelift procedure on a thirty-three year old patient. If the problem is truly a disproportionate fat face, liposuction could be considered an option in the neck area however, I highly discourage liposuction to the face. Facial fat is very important and it is lost naturally as we age. Therefore, I do not recommend liposuction or removal of fat to the face and I do not recommend a facelift for the reason of facial fat only.  

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Chubby cheeks

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Fullness in your lower cheeks is a very common trait that is quite difficult to correct completely, however improvement can be made surgically. Without seeing your photos, I'll answer the question in general terms. You are very young to have a facelift, but assuming this is what you're interested in exploring I'm going to address to the question of what surgical option is most likely to be effective.

There are few surgeon's that resect Bichat's fat pad during a facelift since it is in a territory referred to as tiger country because of the high conentration of facial nerve branches. You should find the ABPS BOARD CERTIFIED PLASTIC SURGEON in your area that is comfortable with this and has photos to share his experience with you.

Yes, once the fat pad is decompressed/reduced there will be sagging cheek tissues. These will need to be lifted and resuspended thus requiring a facelift.

Some resect this tissue with a tiny suction cannula but I think that's not a safe way of doing it since there are so many facial nerves there that control the movement in the corner of your mouth, suctioning is a blind technique and not my favorite way of doing it for that reason.

Lastly, I would warn you against your initial hunch of just tugging the skin laterally showing a significant improvement. There's plenty of people out there that would do that for a small fee. The tension will be there with a facelift but it will not fully correct the problem in the long term.

Eventually, the tissues from the pull will relax, the facelift scar will widen (over the years), and the cheek will bulge back through an unnatural "lateral sweep," where the wrinkles on your cheek sweep in the shape of a nike swoosh! It is potentially a pretty unnatual look. If you only lift up on your jawline and don't lift up your cheek, how will it look later on when your cheek continues to descend and your jawline didn't? My intent isn't to pose more problems, it is simply to reinforce the fact that your anatomy requires the skill of an ABPS Board Certified Plastic Surgeon that does Aesthetic Surgery.

The marionette lines can be improved with fillers, not a biggie. The turned down corners of your mouth is a little trickier but I've seen great great results just by using fillers causing some really nice optical illusions that show drastic improvements.

Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

Puffy face with fatty lower cheeks

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It seems like sagging cheeks coming close the corner of your mouth are making you look heavier in the face than you really are.

Stand if front of a mirror and pull the cheeks towards the earlobes. If it eliminates that look, then you are a candidate for a facelift. If the upper cheeks are hollow compared to the lower, then you can get a filler like Radiesse or Sculptra to balance out the face and it would look less puffy.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Facelift options

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
You sound too young for a facelift. Perhaps liposuction of your cheeks and jowls are sufficient at this time, however, I would not rule out the lipo combined with the facelift entirely.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Facelift at Age 33

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The majority of patients seeking Facelift are age 50 and older.  A person in their 30's is generally not a candidate for a variety of reasons, but most importantly because the aging changes that can be addressed by Facelift are not present.  Secondly, Facelift is not usually considered a "facial slimming" procedure.  What would be most valuable to you would be a consultation with a Board Certified facial Plastic Surgeon or Plastic surgeon in your area.  There are some noninvasive treatment modalities, like Botox, which can reduce the size of your parotid gland and masseter muscles on a temporary basis.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Inventory your best facial features

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Scan your face and identify your best features, just as you have the areas of dissatifaction, then look at your parents' faces, which will give you an idea of how you will age. As a generality, facial aging either occurs like a deflated beach ball or fat accumulation.  The marionette's lines can be addressed with HA (hyaluronic acid) augmentation, the puffy cheeks with judicious Smart Lipo and the relative skin laxity with good skin care and/or make-up.  Very few individuals aged 33 require facelifts.  I concur that it would be preferable to use less invasive procedures, which can be adjusted to suit your facial aging.  Remember, even a facelift doesn't last forever.  By sampling the minimally invasive techniques, you will be able to adjust your looks, as you age.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

Facelift at 33

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Iit is unlikely that at 33 you need a facelift.  Again, photos would be great to see to offer a suggestion.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Facelift for 33 Year Old Bottom Heavy Face

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is difficult to asses you without pictures but most likely you would not be a candidate for a facelift.  First of all, patients who complain of excess "fat" in face or neck or any other portion of body should use diet and exercise as means of addressing.  In some cases, neck and facial fat is resistant to changes here despite making an admirable effort in slimming down.  Facial liposuction is typically a bad idea in a face because it can leave subtle irregularities in the skin contour, while neck liposuction is safe to perform.  

All faces are different and in your case analysis with a surgeon may help achieve a better balance and proportion to your face and could include buccal fat removal, botox facial reshaping, use of facial fillers to just simply recommending a good diet and exercise plan.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Facelift for a young cheeky patient

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

What you are describing is tough.  If it were possible to lose some weight, this might be the best solution of all.  If not, a facelift might actually be a consideration.  A photo would help but please visit some excellent plastic surgeons or facial plastic surgeons and get some first hand thoughts.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.