Skin around mouth, folds and sagging. 38 years old.

I need some advice re my lower face particularly, it has started to loose it's "tightness". Through I don't have jowls as such, if I pull the sides of my mouth down, I can see bulges either sides of my mouth. I also have what looks like folds either sides of my mouth, not lines but literally little folds. -: I said, no actual dropping skin beneath the jaw. I'm 38 and looking for help in the uk now. I would rather not put my pictures up but happy to send via email.

Doctor Answers 9

Skin around mouth, folds and sagging. 38 years old.

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Facial rejuvenation varies from surgeon to surgeon and means different things to different patients. In general it is the process to try to reverse the facial appearance caused by aging. It may involve improving the skin texture and complexion, diminishing skin discoloration, minimizing fine lines and wrinkles, contouring hollows, or tightening loose tissue that has lost its elasticity. 

There are a variety of procedures, both non-surgical and surgical which can be utilized to achieve these various goals. Fillers, Botox or Dysport, micro-fat grafts, chemical peels, a skin care program, lasers, skin tightening, and surgical lifts are some of the methods that are used to achieve a cosmetic improvement. Each has advantages and disadvantages as well as limitations of what they can achieve. The best technique or combination of procedures depends on patient concern, desired outcome, individual anatomy, underlying medical health, and extent of aging. There is no one approach that is ideal for everyone.

I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with who has all of the modalities of treatment available. If you live outside of the United States, the surgeon should

ideally be a member of the International Society of Aesthetic Plastic Surgery (ISAPS). 

You should discuss your concerns with that surgeon in person. Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla, California

La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

What Age is Best for a Facelift

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A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift. During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.

Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

You have lots of options including Fillers, Injectables, Energy & Facial Plastic Surgery.

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A common complaint in women as they age is sagging skin and facial folds. This is due to: 

  1. gravity
  2. environment
  3. facial movements
  4. decreased cellular turnover of the skin 

The muscles and skin of the cheeks, neck and jawline can lose elasticity, firmness and tone. This can lead to sagging and drooping of the lower face, making individuals appear tired or unhappy. 

An excellent way to combat these concerns non-surgically is with a liquid facelift. This treatment combines dermal fillers with skin rejuvenation in order to brighten and tighten the skin, while filling in facial folds. Dermal fillers such as Juvederm and Restylane add volume to wrinkles and facial folds, typically lasting 6 months. Relaxers such as Dysport or Botox reduce deep set facial folds by relaxing the muscles causing the facial lines. 

Skin resurfacing can be done with radio-frequency or laser energy and improve the tone and texture of an aging face. 

Facial plastic surgery is also an option that will tighten the skin around the jowls and neck. A consultation with a board certified facial plastic surgeon is the best way to determine the best course of treatment based on your individual needs. 

Julio F. Gallo, MD
Miami Facial Plastic Surgeon

Perioral rejuvenation

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Without in-person evaluation or set of photos it is impossible to give you good advice. However, based on your description and your age it seems that most of your problems could be treated with injection of soft tissue fillers. In some cases (deep Marionette lines at the corner of the mouth) direct surgical excision may help. 

You would benefit from consultation with a board certified plastic surgeon with good reputation in facial rejuvenation including fillers and/or surgery. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Skin around mouth amenable to facelift

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Easiest fix for perioral lines is a filler hyaluronic acids work well Restylane, Juvederm among others. However if there is a sagging of the skin a facelift may fix it for an extended period versus the six month fix from most commercial fillers. See a board certified ASAPS plastic surgeon in consultation that has the full knowledge and capabilities to do you service. Good luck...

Larry Weinstein, MD
Morristown Plastic Surgeon
4.9 out of 5 stars 11 reviews

Concept Facelift

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Dear Claudia78

Thank you for your question. There are many different types of Facelifts surgeons perform, so make sure you do some research and find a board certified surgeon who has the right type of procedure for you. I have pioneered the Concept Facelift. This is a revolutionary technique where I perform the facelift under local anaesthetic, which minimises swelling and bruising and the down time is only 1 week post surgery. The procedure address the SMAS muscle as well as the skin so the longevity is as good as a traditional facelift. Unlike a Traditional Facelift procedure the patient does not require any drains or bandages and it is a walk in - walk out procedure. The Concept Facelift addresses the lower face, smoothing out any lines and removing the jowls. Many of my patients combine the Facelift with a Neck lift as this gives fantastic results. 

Facial Filers: augmenting the cheek to rejuvenate the lower face

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Facial fillers are injected to improve the volume, contours, and symmetry of the face. 

Facial fillers can be used to augment the cheek area that had shrunken and fallen down. This technique can project the cheek and recruit the skin that has settled on the sides of your mouth and jowl. This is particularly helpful in patients with good skin quality and early facial volume loss. I recommend a consultation so you can be examined for a treatment that will produce a safe and happy outcomes for you. Safety comes first.

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Sagging Skin Around Mouth--Combination Approach: Sculptra, RF (Venus Viva), Botox, Fillers

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Lifting around the mouth can be treated with Botox.  In our practice we combine Botox with other fillers "layered" on top to get the most conservative natural look. Sculptra would be good for collagen building, RF treatments and ultrasound can be used for skin tightening. Please see a facial sculpting expert. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Skin around mouth, folds and sagging. 38 years old.

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 Hi, I have performed facial shaping and facelifts for over 30 years and have performed many minimally, invasive type facelifts on women in their late twenties and early thirties that had "early jowl" formation.  Non smiling photos of your face from the front and side would help in the evaluation.  

 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.

 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 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 and highly effective.

 If you have "jowls” these 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 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 anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed from the face and neck
  • excess skin removed from the face and neck
  • 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.  If you son't have "jowls" precise placement of a dermal filler can be used to soften folds by the mouth called "marionette lines".

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

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.