Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek implants, chin implants and lip implants), liposuction and/or facelifts for over 30 years...including SMAS and minimally, invasive SMAS type facelifts. The photo shows mid cheeks grooves (indicate cheek fat has sagged off the underlying cheek bone that lacks adequate supporting volume), the cheeks are quite flat in the front, there is excess fat in the mid face however and the back portion of the jaw line is weak however there is no evidence of "jowls" in the lower face. While it's not impossible for a 27 year old female to have jowls (who would therefore be considered a facelift candidate), this photo does not reveal jowls in the lower face which means you would not be considered a suitable candidate for any type of facelift procedure (described below). All of the above mentioned contribute to create a thin, elongated, oval to rectangularly-shaped face. Following my beauty principles, 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. When the cheeks are flat or concave in the front, cheek augmentation with a dermal filler or using silastic cheek implants (permanent enhancement) can create full, round cheeks that will feminize the entire face. Liposuction to reduce excess fat can be used to further shape the cheeks and face. There are many faces that have excess fat over the cheek area which hides the "true" shape of the cheeks below. In addition to obstructing the cheek shape, this excess fat will sag prematurely as it is pulled by gravity at an accelerated rate versus a face without excess fat in the mid face. Removal of the excess fat, with liposuction, is key when properly shaping the cheeks with cheek implants. I have used this in combination with cheek implant surgery for 30 years. In my experience these procedures when combined in a face with excess fat in the mid face are extremely safe, effective and reliable in the aesthetic results they produce. 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). Finally, the information on the minimally invasive SMAS facelift is indicated as a possible explanation of why your re being turned down for a requested facelift procedure. If you have "jowls” these are sagging facial tissues and the main 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 SMAS facelift is the minimally invasive, short incision SMAS 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 anesthesiaproper SMAS Imbrication techniqueno incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost 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.