Sagging cheeks like a bulldog - what can I do? (photos)

The good news is that the kinds of problems you demonstrate in the photos, which are seen daily by those of us who specialize in aesthetic medicine, i.e. the loss of volume, especially in the infraorbital region and the upper inner portion of the cheek (on the side toward the nose), the deepening smile lines and marionette lines, the incipient jowl formation along the jawline, the loss of volume in the upper lip ( in particular), and the development of "bar code" (aka "smoker's lines" or "lipstick bleeding lines") above the upper lip, and the suggestion of some downturning of the outer third of the eyebrows are ALL easily amenable to the advanced uses of injectable volumizers and fillers. In experienced hands, treatment of all the above should not take more than about 45 minutes without the need for cutting, stitches, or any significant downtime. I would suggest that you check out the archives of RealSelf.com using the search terms: The Nonsurgical 3D Vectoring FaceliftThe Nonsurgical Treatment of Under Eye Tear Troughs, Hollows, & Dark Circles; The Nonsurgical Mid-Face Rejuvenation; Nonsurgical Lip Augmentation; Fillers For Treating Fine Lines & Crepeyness; The Nonsurgical Treatment Of Jowls Along The Jawline. For most of the procedures the results engender an immediate "Wow!" reaction.  So, don't despair. Just do your homework and then your due diligence in finding a board certified aesthetic core physician. As part of your vetting, be sure to ask to see his/her before and after photos for the treatment of each area. Best of luck to you.

Hello and thank you for your question. Based on your photograph, you may benefit from a mini facelift with a neck lift.  If good technique is used, this can be done with minimal scarring and can result in a natural look, not over-done look, with rejuvenation of your face.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.Harvard-trained plastic surgeon