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

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!

Doctor Answers 8

Mini facelift at 28?

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 

Sacramento Plastic Surgeon
4.9 out of 5 stars 109 reviews

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

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

Tariq Ahmad, MBBChir, FRCS(Plast)
London Plastic Surgeon
5.0 out of 5 stars 8 reviews

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

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years. From the photo, your cheeks are flat anteriorly (in the front) which allows the tissues to fall and sag towards the mouth.  There appear to be "jowls" as well as lower eyelid fat pads, although a full photo of the eyes would confirm this and I suspect that the chin is weak (can be confirmed with a non smiling side photo of your face).  These combine to create an elongated, oval shaping faced.  Following the beauty principles outlined in my book on face and body beauty, 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. 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. If 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 that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.    Think of facial beauty as something that "must" address all layers of the face including the skeletal structure of the cheeks and chin, the overlying SMAS muscle, amount and position of subcutaneous fat and finally the degree of skin laxity. It's an "urban myth" that pulling tissues over flat cheeks and a weak chin can create a beautiful or handsome face. Similarly, dermal fillers or facial implants alone can't lift and remove excess skin from the face and neck. Natural looking beauty is created by the aesthetic vision of what tissue layers need to be adjusted by what technique and amount. I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.
"Jowls” are sagging facial tissues and an 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 facelift is the minimally invasive, short incision 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
  • 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 anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most 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.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

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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.

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Dear Caligirly88, An in office examination would be advised to determine the best course of action for a patient your age. Most likely I would suggest buccal fat pad extraction to reduce the fullness in the lower third of the face providing better balance to your overall facial aesthetics. I am not a big fan of fillers in the lower eyelids however some fillers to augment the cheek area as well as the buccal fat pad removal may be a nice combination to provide a more youthful and feminine appearance. An example of buccal fat pad removal in the video above and link below. Best regards, Michael V. Elam, M.D.

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Combination of under eye filler injection and lower cheek buccal fat removal

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. 

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Cheek implants, lower eyelid surgery and filler placement for nasolabial folds

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

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Sagging cheeks.

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 

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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.