My face is sagging after facial feminisation (jawbone reduction) and cheek implants removal. Cheek lift? Jaw implants? (Photo)

My jawbone was reduced so i would look more feminine. In stead I look older and my jawline is gone! Im 30 years old but I look like 45 :´( I hade too big cheek implants so i replaced them with smaller implants so my cheeks are sagging as well I look like a mess and I get so depressed from my refelction in the mirror. Costum made jaw angle implants? Cheek lift? Pixie ears surgery? I need help! It looks like my face is melting... Best regards, E :´(

Doctor Answers 2

Sagging face after "feminization"!

I have done facial feminization for more than 35 years and I do not recommend removal of the jaw since you need it to balance the face. I need to see your face and feel it to tell you which of several ways to fix several of your problems.

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Cheek lift? Jaw implants?

Hi, I have performed facelifts for over 30 years. From the photos your cheeks are very flat (concave) anteriorly (in the front) and the chin is very weak which combine to create a rectangular 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. I shape the cheeks, chin and jaw line with every facelift procedure.  The scars seem to indicate that you had some type of a facelift that was pulled tightly which can results in stretch back and widened scars.  Until there is sufficient excess skin to revise these scars, no further surgery in that area should be undertaken as this will most likely result in even more stretch back and wider scars.  These types of scars can occur with a "skin only" type facelift where the SMAS layer is not properly dissected, elevated, trimmed and re-sutured.  I have included information on my SMAS facelift below for comparison.

If you are not interested in using cheek and chin implants to shape and contour your face, dermal fillers can offer an alternative if properly placed by an experienced facial shaping expert.  Dermal filler can also be used to bring out the mandibular angles.  

If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation. I have performed many Cheek Augmentations over the past 30 years and the notion that Cheek Implants or dermal fillers to the cheeks will lift tissues is an urban myth. Filler to the cheeks or cheek implants will shape the cheeks but will not lift up the jowls. 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 and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • 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
Hope this helps.

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