How can I fix my lower face - Mini Facelift or Chin Implant or Both? (photos)

Question

Over the last five years I developed large masseter muscles. They are now gone because of Botox sessions over the last 2 years and a night guard fitting a year ago but I think the Botox has given me laxity jowls. I'm 35 years old. My question is, how can I fix the lower part of my face? I'd also like to add that I have had Radiesse in my chin twice now and it doesn't seem to be fixing the pre jowl depressions. I also have tried filler and Sculptra in cheeks, pre jowl, and temples for lifting.

George Yang, MD · Answer

Hi, A chin implant will further project your chin forward, but will not flatten out the jowl. There are specialized Mittleman Prejowl chin implants with no projection on the front of the chin, but only on the prejowl area. A mini-facelift will not return you to the photo from 5 years ago. What looks good in youth the wide area of cheek and chin around the mouth area. The wide "frame" around the mouth helps to highlight nice features like the lips. However, when botox of the masseter is performed, it does narrow the width of the lower face at the jaw angle, but it reduces the amount of lower cheek/jawline just to the side of the lips. Looking at your younger photo, if we look at your lower face and the level of the lips, your right cheek is about 30%, your lips are 40% and the left cheek is about 30%. Your current photos appear that the right cheek is 25%, lips 50%, and left cheek is 25%. If you look from the line between your lips going down to the contour of the chin and jaw, your younger photos show a ratio of 30% lower lip and 70% chin. Your current photos show about a lip to chin ratio of about 40% to 60%. The #Russianlips borrowed 10% of the distance from your chin and gave it to your lips. Now the chin and jawline look smaller relative to the lips. A mini-facelift might pull the jawline/jowl slightly flatter, but it may only make your lips appear even bigger relative to your chin and jawline. Before embarking on bigger and bigger surgeries to address procedures you have had in the past, consider reversing some of them little by little to see if it helps create balance. Remember, a little bit of a good thing is good, but too much of a good thing can be bad. If you stop the botox to the masseter or don't want to, then adding back some width to the jaw angle/lower jawline will look more like your younger photo. In your younger photo, the width of your lower cheek at the level of the lips was about 90-95% of the width of the cheekbone area. Currently the same comparison shows a much narrower lower face, without give a V-line or heart shape, which is 80-85% compared to the width at the level of the cheekbones. If your look at your current right side which is on the left side of the photo, that side looks wider around the cheek and chin side of the lips while the other side seems smaller and doesn't have as much width. Note the jowl on the right side looks better and smoother than the left side. These all have a correlation. When one area is treated on the face, it can affect another. Be careful not to do too much to your face. You only have one. Hope this analysis provided some value to you. Keep doing your research. Realself is a great resource. Good luck. Best, Dr. Yang

Jason Emer, MD · Answer

It's difficult to say without the benefit of a formal evaluation. This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. While a personal evaluation is best to assess your skin and facial profile, skin laxity after Botox injections to the masseter can be addressed in many ways. You may try a combination of non-surgical skin tightening procedures such as laser and energy treatments, including RF microneedling (Profound RF). A combination of injectables can give you a non-surgical facelift too, including chin augmentation.

If you want a more aggressive approach that provides more dramatic and longer-lasting results, you may consider a PDO threadlift or a mini facelift to address your slight jowl formation. To determine the best procedure(s) for your concerns, I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon can properly evaluate your skin quality and facial profile, determine your eligibility for a mini facelift or chin implant procedure, and ensure the best possible results.

Brian K. Machida, MD, FACS · Answer

You have undergone some volume loss to your face.  Volume from Sculptra and fillers for the purpose of lifting only helps to a minor degree.  At this point, after you've tried volume replacement, your next option would be a facelift.

Barry L. Eppley, MD, DMD · Answer

When you lose support volume for the lower facial tissues, which is what occurs in masseter muscle reduction, one can develop soft tissue laxity along the jawline. It is very difficult to 'fill' one's way out of this loose tissue. A limited lower facelift or jowl tuckup is what is needed to smooth out the jawline or fix  the lower part of your face.

Darryl J. Blinski, MD · Answer

Best to have in person or even virtual consult. My over the Real Self internet guess is a mini FaceLift with SMAS plication and either Ha fillers or nano fat grafts to mandibular jugal groove. Can not tell if you need chin implant from only posted frontal viewed photos. Fees in $10,000 ranges.

How can I fix my lower face - Mini Facelift or Chin Implant or Both? (photos)

Answers (6)

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