Which procedure is suggested to lift sagging cheeks, under eye bags and nasolabial folds? (Photo)

Question

Hello, I have been tormented by my saggy cheeks for my entire life it feels. As I have gotten older, my nasolabial folds and under eye bags have become more pronounced. I also have some acne scarring on my cheeks and outer chin. Would a mini facelift do the trick to soften all of these issues? I am 28 btw. Your responses are greatly appreciated. Thanks!

Jason Emer, MD · Answer

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Jed H. Horowitz, MD, FACS · Answer

Hello caligirlCheek implants are available in a range of different shapes and sizes, they are mostly customized to fit a specific facial structure. Fillers such as Juvederm Voluma, Radiesse and RestylaneLyft are great alternatives to cheek implants, also fat transfer or injection can be done.

Mehryar (Ray) Taban, MD, FACS · Answer

Not sure if you need any lifting as it is more invasive and possibly giving surgical look at this young age. You can achieve natural results by doing some filler injection in hollow under eye area and possibly removing some buccal fat from lower cheek area.

Michael J. Yaremchuk, MD (license resigned) · Answer

The malar area is the most projecting part of the midface skeleton. It is what we consider the "cheekbone." Prominent malar bones are considered attractive. Hence, the malar area is frequently augmented with implants. Oftentimes, a deficiency in cheek prominence is part of a more generalized deficiency in the midface skeleton. For that reason, malar (cheek) implants are often used in combination with other implants - most frequently, with infraorbital rim implants, which build up the area directly beneath the eye.

Tariq Ahmad, MBBChir, FRCS(Plast) · Answer

There are a number of methods to get the result that you have indicated you wish to achieve; obviously we have both non-surgical and surgical routes; it depends on the level of improvement you wish to gain and of course what you may be prepared to go through to get there. Non-surgical options are relatively straightforward with less down time but would need to be repeated however with the range of products an experienced practitioner may be able to achieve really excellent results for you.

Surgically speaking the combination of your concerns in relation to cheeks lower eyelid bags and nasolabial folds represent an opportunity to use the latest blepharoplasty techniques to both soften the lower eyelid bags by redraping them to fill out the tear troughs whilst also lifting the cheeks by suturing the cheek fat higher up to the bone at the sides of the eyes thereby also improving the nasolabial folds; a SOOF lift. Hitching to something immovable like the lining of the bone means that the results should be long lasting yet, in experienced hands, also very natural.

best wishes

George Orloff, MD, FACS · Answer

There are good surgical and nonsurgical options.  Nonsurgical options involve the use of fillers to fill in the upper cheek area.  A little bit goes a long way.  Lifting the central upper cheek area softens the nasolabial fold. It is best to develop a relationship with a qualified injector to work up to the best look for you.  In other words start off with a little bit and let it settle then return for more,... if necessary.  Gradually work towards the best look for you.  Surgically, the mid face cheek lift is ideal for your facial characteristics.  The results are very natural with no visible scarring.   I think the above two options work well.

William Portuese, MD · Answer

When patients have a flat maxilla and a flat cheek profile, cheek implants offer permanent augmentation for volume restoration in that area.  Fillers can also be used for that purpose, but are only temporary.  Fillers work very well  to improve the nasal labial fullness.  The primary  goal of lower eyelid surgery is to remove fatty deposits creating the eye bags in the lower lids.  A transconjunctival approach accomplishes removal of the fatty deposits to improve the puffiness look.  Both procedures can be performed together when necessary.  A full set of facial photographs are required to make a determination about what may be needed in addition to in-person examination. For more information and many examples of both procedures, please see the video and the link below

Ben Talei, MD · Answer

in short, the best choices are either using fillers, tightening device like the profound or an extended deep plane cheek lift like the auralyft. I would absolutely stay away from fat grafting and implants in your face

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You submitted a photo with your eyes blocked out, describing a situation where you’ve had sagging cheeks for your entire life, and your nasolabial folds are worsening as you get older, even if you are still young at 28-years-old. You also state you have under eye bags, which we can’t see in your blocked out image. You ask if there is some way to lift the area of the cheeks to improve the overall appearance. You also mention some acne scarring.
I can certainly help you understand what is probably contributing to this perception. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and I perform a full range of procedures including minimally invasive, to advanced surgical procedures, so I can give you an understanding of how I would interpret what you describe. 
At 28, you are still very young, so what you have dealt with throughout your life is more about anatomy and not about age-related changes. You can have the perception your cheeks are sagging, but I believe what is equally relevant and probably more appropriate for you is your cheek is not well-defined. There is a difference how we treat people with facial aging, which is about restoring volume loss and sagging. With younger people, it is more about subtle but natural-looking enhancement to beautify and create balance. I would suggest for someone like yourself to do the least amount possible to try to get the best outcome. 
For the cheek and nasolabial folds aspects, it is worth considering a procedure we call structural volumizing. Structural volumizing is the application of traditional fillers such as Juvederm Ultra Plus and Juvederm Voluma, but in placement different than traditional filler application. Traditional fillers are typically placed in the cheeks, and right under the skin whether it is in the nasolabial folds or the cheeks. In structural volumizing, we are placing it between the bone and muscle. We do this keeping the Golden Ratio of facial harmony facial balance in mind, which is a width of 1.6 to 1, so the upper part of the face is slightly wider than the lower part. Interestingly, it can make a person look thinner. The Golden Ratio is a concept that has been around since ancient times. With structural volumizing in the cheekbone area, accentuating the cheekbones can actually really enhance the overall appearance of the face. What I like about considering a hyaluronic acid filler like those I mentioned is in a worst case scenario, you can dissolve these fillers and start from scratch. The reversibility of this approach makes it very appealing.
If you have had under eye bags for most of your life, then there is a very good chance you are dealing with lower eyelid fat prolapse, which means that the fat pockets normally around the eyes pushed forward and created a bulge. I’m not getting ahead of ourselves and saying you are a good candidate for one procedure or another, but the options for under eye bags in my practice are based on the relative prominence of the under eye bags. If they are subtle, they can be blended with an injectable filler like Restylane to fill the area of the tear trough to create a better transition between the under eye bags and the adjacent area. We also use platelet-rich plasma (PRP) derived from your own blood, but that is a different story if you don’t have much wrinkling or discoloration under the eyes. If the under eye bag is more prominent, it is not amenable or appropriate to treat this area with fillers because you might create too much volume. In such cases the option is a procedure called lower eyelid blepharoplasty, specifically a transconjunctival blepharoplasty. 
I recommend you take little steps. You are still very young, so my personal style is to tend to be very conservative. I always tell younger people that once you get into your 40s and over, there will be plenty of opportunities to do things because facial aging changes will manifest more significantly. Prior to that, little things can go a long way, whether it is cheek augmentation or lip augmentation. Little things can make a nice difference for people who genetically do not have volume on those areas they desire to address. 
Learn about these options, and find a doctor you are comfortable with. You really need to feel comfortable with the doctor’s style, their aesthetic, learn about what you like, and what you want to try. Very often, when we discuss these issues with patients, we come up with a priority list, figure out what’s the highest priority, and go with what has the most significant impact, cost the least, and will likely be satisfactory. You may need to visit a few different doctors to find what you are comfortable with, then move forward to take your first step.I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Andrew Kaczynski, MD (retired) · Answer

You raise a host of very interesting questions.  Because you blacked out your eyes it is difficult to tell what is going on there  However from your photos it does appear that you have some under eye bags.  In general with younger people it is usually best to start out with less invasive options. You might be a good candidate for filler into the nasolabial fold's and at the infra orbital rim . You might be a candidate for a cheek lift with lower blepharoplasty and  fat grafting to the nasolabial fold But cheek lift alone will not affect the appearance of lower eyelid bags.  The only way to really tell which option would be best for you is to see a board-certified plastic surgeon who is experienced with facial plastic surgery including fillers and fat grafting

Which procedure is suggested to lift sagging cheeks, under eye bags and nasolabial folds? (Photo)

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