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

My lower face seems to be sagging, with what seems to be small pockets of fat around my mouth, making me look than I am. I also have a very small chin, which I think worsens the problem. Although the pictures might give another impression, I'm normal weight. My family just seems to carry a lot of fat on their lower face... What are my options in terms of improving this area ? Looking for non- or minimally invasive procedures with little downtime. Non-permanent effects is not a problem.

Doctor Answers 13

UAL cervical facial

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Please seek an in person consultation, you may be a candidate for simple liposuction of the area. Liposuction of the cervical facial area is usually done in one hour under local IV sedation. In my practice in the San Francisco Bay Area I have come to the conclusion that the happiest patients are those that have realistic expectation on what a procedure will and won’t do for them. Good luck!

Dean Vistnes,M.D.

Vistnes Plastic Surgery

#realself #drdeanvistnes #liposuction #cervicalfacial

Bay Area Plastic Surgeon
4.9 out of 5 stars 51 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

Silhouette Instalift and Kybella

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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!

The balance of surgery vs. No surgery

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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


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Improve lower face

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Thank you for your question about lower face.

  • Although it is always nice to have minimally invasive treatment, it is usually wiser to have the correct treatment.
  • Fillers in your lower face will make it look heavier.
  • You have a structural problem - too small a chin and excess fat and loose muscle beneath.
  • You need a chin implant and a neck lift and will love the result.

Always consult a Board Certified Plastic Surgeon. Best wishes. Elizabeth Morgan MD

Genetics and Small Chins

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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!

Paul Lanfranchi, DO, FAOCO
Las Vegas Facial Plastic Surgeon
4.9 out of 5 stars 79 reviews

Creating Facial Structure

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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 

Lower Face: chin

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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. 

Mark Karolak, DO, FAOCO
Bridgewater Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

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

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 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 photos, your cheeks are very flat in the front, there is excess fat below and in front of the cheeks, chin is weak but there are no signs of "jowl" formation.  As described below the "jowls" are the main indication for some version of a facelift.  These combine to create an elongated, oval shaped face.  

 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.  This can be combined with liposuction for further shaping of the cheeks and face.  

 I have performed many Chin Augmentations using chin implants for over 30 years.  From the photos, your chin is weak.  A weak chin 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.  In my opinion, you are a good candidate for chin implant surgery.

 The back portion of your jaw line is a bit weak and can be augmented, without making your face appear masculine, using precise placement of a dermal filler (I prefer using Restylane Lyft).

  I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  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
  • 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
4.7 out of 5 stars 28 reviews

Saging lower face

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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

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