Tired looking, sagging lower face area, 29 year old woman. What can be done? (Photos)

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.

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™.

First of all, thank you for your question.  In looking at your photos I would recommend several things.  I think the new Silhouette Instalift is a 20 minute office-based procedure that can provide some "lift" to the cheeks. This is taking it a step beyond filler without "incisional" surgery.  I would also recommend Kybella to "melt" the area of fullness under the chin. Finally, adding filler to the chin can add some jawline improvement.  The final thing that sometimes can help lower cheek fullness is intraoral buccal fat excision, which is removing a small bit of fat we're all born with from a small incision inside the mouth. I hope this helps.  Good luck!

Your question taps into a lot. It is becoming more and more sought after to obtain major results with minimal "work". The industry has responded. There are a plethora of injectables that you can tap into to increase the dimensions of your chin. Kybella can be used to reduce some of the fat of the lower chin and submental area. The results you are looking for however are only going to likely be obtained from neck sculpting with liposuction and a chin implant. 

So you will have to balance that risk vs. reward issue that many of us face every day. Set up a consult with a board certified surgeon who will be honest and discuss the benefits and risks of each. Delineate the results they feel are attainable and then pull the trigger when/if you are ready.



Best of luck



DrC

Genetics certainly plays a significant role when it comes to aging of the lower face and neck. The two most important factors in determining your profile are your chin size and the position of your airway (trachea, hyoid bone, and adam's apple). Patients like yourself typically have a small-sized chin along with a forward positioned airway. This results in having minimal "structure" to hold up and support the tissue from above. Therefore, this type of anatomy often results in faster aging in the neck and jawline/jowls. Even when you were younger (ie in high school) you probably did not have a strong/dramatic profile. Although it is "minor surgery", I would recommend chin augmentation with an implant along with liposuction under the chin. In expert hands, the risks are quite minimal, and the recovery time is under one week. This combination of procedures will give you many years (even decades) of results and improvement. Depending on your region, the procedure package can cost anywhere from $4-8K. As in our Center, many times the procedures can be performed under local anesthesia with mild oral sedation. The lifetime cost of "non-invasive" treatments (fillers etc.) would far exceed the one time cost of the augmentation and liposuction.  I've attached a weblink that demonstrates a few younger patients, like yourself, who had this procedure. Hope this has been helpful, and good luck to you!

Thank you for your question and pictures.  As you are still very young temporary non-surgical dermal fillers to create an increase sized chin and reshape would be an excellent start, these could also be used in the cheeks, to create a facial structure. If you wanted a surgical option, chin implants would be a good permanent solution.  Neck Liposuction could be considered to create a smoother jawline and contoured neck.  Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve. All The Best 

Based on what I can tell from your pictures, there are a few procedures that I would suggest researching. Non surgically, fillers will be an excellent option. These can be used reshape and increase the size of the chin area. Surgically, a chin implant or fat transfer should help as well. Even with a chin implant, fillers may be of benefit to "fine tune" the area below the lip. Both options should have little downtime.  Fillers should be the quickest recovery and can last several years depending on the product used. The best way determine the approach that you feel most comfortable with is to have an in person consultation with a specialist who performs these procedures on a regular basis and is not limited to one approach. This way you can get an unbiased recommendation. 

Based on your photos it seems that chin augmentation is necessary first step to improvement of lower face, jaws and neck. Additional contouring of the neck, along jawline, possibly cheeks with conservative liposuction using small cannula would help.

You should seek a consultation with an experienced board certified plastic surgeon with good reputation in facial rejuvenation/contouring for clinical evaluation and to discuss your options. Good luck

You look like a great candidate for a chin implant. That alone will significantly improve your appearance. If you added a lower facelift, that would redefine your jawline and tighten your neck. Both can be done as outpatient procedures under local anesthesia. See an experienced, board certified plastic surgeon. Good luck!

The photographs demonstrate a weak and recessesive chin profile for which a chin implant can improve significantly.  Chin implants are placed through a small incision underneath the chin under local anesthesia as an outpatient surgical procedure which takes approximately 30 minutes.  The Implants themselves are composed of Silastic,  and are manufactured in a large variety of sizes and shapes.  In our practice, we have been using Implantech chin implants for over 25 years with an excellent success rate.  For many before and after examples and diagrams of the implants themselves, please see the link and below