Sagging and loosing volume - Filler vs fat transfer vs face lift? (Photo)

Question

I'm in my 30s but have always had this shape under my bottom lip above my chin (see photo). I feel it makes me look older and I want to smooth it out. I also find my cheeks are sagging and losing volume . I was considering doing a lip lift as well to add more youth. I'm not super keen on filling my face for the rest of my life (I also get puffy easily due to allergies) and I've heard that menopause can make fillers really look bad later. Plus I'm concerned about lymph blockage etc. Would a fat transfer in these areas make more sense for me? Or if there a non invasive procedure that is better? or should I just do a lower /midface lift already? Thank you!

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and the photo. I completely understand how frustrating it can feel when subtle changes in the chin and midface make you feel older than you are. You’re thinking about this very carefully, which is important because each option has different benefits, longevity, and considerations.

1. Dermal Fillers:

Fillers can restore volume and soften the area under the lip and along the cheeks, giving a more youthful appearance.

They are minimally invasive, but as you mentioned, they are temporary and require maintenance.

In patients prone to puffiness or later changes from menopause, fillers can sometimes become less predictable over time.

Lymphatic drainage is usually not significantly affected, but excessive or deep filler placement could potentially alter tissue contour subtly.

2. Fat Transfer:

Fat transfer is a longer-lasting option because it uses your own tissue to restore volume.

It can address multiple areas—under the lip, cheeks, and midface—at once.

The main limitations are that fat survival can be variable, and some procedures may require touch-ups.

Recovery is longer than fillers but shorter than a surgical facelift.

It generally avoids the “puffiness” concern you noted with fillers.

3. Surgical Lift (Lower / Midface Lift):

A surgical lift addresses skin laxity and sagging rather than just volume loss.

It is more invasive and has longer recovery, but it can provide a more definitive and long-lasting improvement in contour.

Fat transfer can be combined with a facelift to both restore volume and tighten tissue, giving the most natural, youthful result.

4. Non-invasive options:

Energy-based skin tightening (radiofrequency, ultrasound) can provide modest lifting and collagen stimulation.

These are less invasive but typically provide subtle results compared to fillers, fat transfer, or surgery.

Bottom line:

For volume restoration in your 30s with natural tissue, fat transfer is an excellent option and avoids long-term filler maintenance.

If your main concern is sagging or loose skin, a surgical lower or midface lift addresses that more effectively.

Often, a combination approach—fat transfer for volume plus a targeted lift for sagging—offers the most natural, lasting results.

You’re asking the right questions about long-term facial harmony. The key is balancing volume restoration with contour and avoiding overcorrection, especially in areas prone to puffiness.

Sagging and loosing volume - Filler vs fat transfer vs face lift? (Photo)

Answers (1)

More Dermal Fillers Questions

How can I reduce under eye lines? (Photo)

Is it better to dissolve HA fillers sooner rather than later? (Photos)

Flat face, bulging eyes, too much upper eyelid exposure - will filler cause a pillowy, unnatural face? (Photos)

Permanent bruise from under eye filler two years ago - how can I treat this? (Photos)

How likely is it for filler to be visible on an mri?

Dissolving redensity 2 tear trough - what should my next steps be to fix purple under eyes? (Photo)

WE SEND PRETTY
EMAILS