What’s the best treatment option for my sagging jowl? I’m a 28 year old female. (Photos)

Question

I started noticing sagging in my jowl this year. The weird thing is, the sagging is only in the right side of my face. It’s still nice and perky on the left side. I’m overweight (5’4”, 170 pounds), and wonder if losing the weight could reduce the noticeability of the jowl? Also: why did this happen so early? Stress? Lifestyle? I work a computer job, so I’m wondering if this could be screen face? Also, should I consider cool sculpting, fillers or something similar?

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.

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

Thank you for your question and pictures.  Yes, losing weight can help change the shape of your face.  I would suggest trying to lose the weight first and possibly try some cheek fillers.  These are temporary but will help to add some volume and symmetry to your face.  You could have some liposuction under the chin and jawline to contour and give more of an L shaped neck and really define the jawline which is very slimming.  Please have a consultation with a board certified plastic surgeon.  All The Best

Jed H. Horowitz, MD, FACS · Answer

Hello cfaulknI would advice you visit a board certified plastic surgeon fo physical examination to help you make the right decision.

Chad K. Wheeler, MD · Answer

there is a variety of causes to jowls in youth.  Significant weight gain or loss is probably the most common.  I suggest obtaining an ideal weight before attempting to address the jowls as future weight loss may have an impact on the appearance.  Jowls older people is often a sign of bone loss in the face and lack of support which can be addressed with facial fillers and surgery but this does not appear to the case here.

Sabrina Fabi, MD · Answer

There could be many reasons at the root of your sagging. The foods you eat, stress levels, amount one sleeps and the amount of exercise you get can have a negative impact on your bone and skin quality. If you smoke, your skin dries and thins out at a younger age than in nonsmokers, for instance. 
As for your immediate problem, Sculptra or Voluma in the midface could add back some of the volume you lost and thus remedy the sagging and early jowls. Ultherapy can also contour and lift the face. Consulting a board-certified dermatologist will let you get some more specific remedies that not only solve this particular problem but ensure that your skin remains in good shape through the coming years.

Sandy Sule, MD · Answer

Looking at your photos, I he loss of volume in the mid face seems to be the biggest issue. There are many reasons for this. Serval fillers can be used to help restore the list volume. However, given your age, you may want to consider more permanent options like submalar implants

Scott E. Kasden, MD, FACS · Answer

Hi cfaulkn5You have some mild cheek ptosis (sagging) that is manifest by some descent of cheek fat pad with mild prominence of your naso-labial and labio-mental folds (marionette lines), jowls, and I can't judge the degree of asymmetry.  The marionette lines appear more prominent on the left side however.Your neck angle is somewhat obtuse consistent with a small amount of submental fat, some lax skin, and possibly some laxity of the platysma.Not to despair.Premature and even aging depends on genetics, smoking, sun exposure, diseases, weight changes, excessive weight changes, and alcohol consumption, to name the most common.I do not recommend CoolSculpting.Fillers can be used with good effect fort the marionette lines.You may consider a cheek lift alone, but you will likely need some lipo of the neck.You may also want to consider a neck lift.If you don't want to do something that "invasive", you may consider neck lipo alone, and this may be adequate to get you happy.Of course, you need to be fully evaluated both physically, and in terms of your goals, and very importantly, what you will and won't be able to go through surgically at this time.All the best, and I hope this helps a bit.sek

William Portuese, MD · Answer

It is important to be at your ideal body weight, since jowls are usually mostly composed of fatty tissue.  In our practice, patient's must have a BMI of less than 34 before undergoing elective cosmetic surgery

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, silastic implants (cheek implants, chin implants, lip implants), liposuction and facelifts (SMAS and minimally invasive SMAS facelifts) for over 30 years.  From the photos your cheeks are concave in the front, there is a slight amount of excess fat that has shifted off the cheeks, jowls are present, the chin is weak as are the back portions of the jaw line and there is some excess fat under the chin and in the neck.  These factors combine to create an elongated, rectangularly shaped face. 
 "Jowls”, in the lower face, represent sagging facial tissues that remain the main indication for some form of a SMAS 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-op I 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.
 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.  With cheeks that are concave or flat in the front, cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Excess fat can be reduced with liposuction to further shape the cheeks, face and neck.
 When the chin is weak, this 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 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. Hope this helps.

Richard W. Fleming, MD (retired) · Answer

Before any cosmetic medical treatment I suggest you lose the weight which will improve your health and possibly avoid the need any procedures.

What’s the best treatment option for my sagging jowl? I’m a 28 year old female. (Photos)

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