What is causing my large, sagging cheeks and what can be done to achieve a more balanced, sculpted and lifted look?

The single most important variable when it comes to facial aesthetics, is bone structure or facial, skeletal structure.
This is what determines each individual persons, unique facial appearance, whether it be attractive or not so much.
Soft tissue coverage tends to be very consistent from person to person and issues. Related to facial aesthetics are almost exclusively. Based on bone structure.
Facial aging is more related to soft tissues, but also has skeletal components.
in particular individuals who have a prominence maxilla with a small mandible will have facial aesthetic issues of the lower 1/3 of the face and neck.
This includes potentially having a premature double chin, lack of jawline, definition, deformation of premature, jowls, etc. Addressing the primary issue from a surgical perspective tends to be complex so people look for more gentle easier solutions. Recognize the treating problems primarily related to bone structure with soft tissue manipulation is inherently going to deliver partial improvements at best.
Because there are no easy solutions to the problem expect providers to have different opinions about the best course of action or treatment options.
To get a more accurate assessment and understanding of treatment options I suggest having multiple in person consultations with plastic surgeons in your community. If you want to have an assessment regarding the primary underlying bone structure, then you may want to talk to oral surgeons or plastic surgeons with cranial facial fellowship training. accepting our own facial structure is important and it’s also important to recognize that we should not turn to surgery unless there is a surgical problem.
Everybody wants to look a little better and this is true whether someone was born with perfect aesthetics or not.
Whether surgery is indicated or justified, becomes a bit of a subjective topic.
What works for one person may not work for someone else. Likewise expect providers to have different opinions on the topic.
The default position should always be to not have surgery unless there is a clear indication and a healthy risk benefit ratio.
Best,
Mats Hagstrom, MD.