100 pound weight loss - Cheeks/chin filler, masseter reduction, and acne scar treatment?

Question

I've had two consults in the last 2 years, one when I was heavier and one this week after a roughly 90-100lb weight loss over the last year. Both consults suggested the same thing, one syringe of restylane contour in each cheek and defyne in my chin to make it more pointed. Where they differ, the first surgeon wanted to add some filler to my jawline, but I was heavier then and I've regained a lot of definition. The surgeon I saw this week suggested xeomin in the masseters to correct asymmetry and reduce the prominence of my lower face. I like this idea, and I've had masseter Botox a few times over the last ten years, but I worry about joweling after my recent weight loss. I want to see a noticeable difference without looking unbalanced. I have always desired more projection in my cheeks but my interpupillary distance is pretty close and I don't want to make my eyes look any closer together. The surgeon I saw a year ago thought I would benefit from subcision for my acne scars, the surgeon I saw this week said there might be some mild improvement that could be made but I'm reaching a point of diminishing returns. I've had two rounds of fractal lasers spaced 2 years apart. I'm currently undergoing laser hair removal on my face as well. My acne has improved but I still get folliculitis following treatment.

Anna Chacon, MD, FAAD · Answer

First, a 90–100 lb weight loss is a major transformation, and it very often changes the entire framework of the face—not just volume, but how the skin drapes, how light reflects off contours, and how underlying muscles and fat compartments behave. So it makes sense that your treatment plan is now evolving compared to when you were heavier.

What you’re describing actually touches on three separate facial balance systems: mid-face support, lower-face muscle width, and skin texture (scarring)—and they need to be considered together rather than as isolated treatments.

1. Cheek and chin filler after major weight loss

The recommendation for cheek and chin filler (Restylane Contour + Defyne) is very consistent with post-weight-loss facial restoration.

After significant weight loss, common changes include:

flattening or deflation of the mid-face
increased shadowing under the eyes
loss of cheek “lift” that subtly affects the jawline
a more tapered or less supported chin profile

Cheek filler in this setting is not about making the face bigger—it’s about rebuilding structural support so the face doesn’t look collapsed or tired.

Regarding your concern about eye spacing:
Filler in the cheeks does not actually bring the eyes closer together. What it can do is change how light transitions across the mid-face. When done conservatively and placed laterally (not too medially), it enhances cheekbone structure without narrowing facial balance.

The key here is placement strategy, not volume alone.

2. Masseter Botox (Xeomin) after weight loss

This is where your concern about jowling is very valid—and thoughtful.

Masseter reduction can:

slim the lower face
improve asymmetry
reduce muscular width from clenching or hypertrophy

However, after significant weight loss, there are two important considerations:

Why jowling risk is a real discussion
The masseter muscle provides some subtle structural “support” to the lower face
When it is reduced too aggressively, especially in someone who has lost fat volume, the jawline can appear less supported
This can make mild skin laxity or early jowling more visible
Why it can still be appropriate

If your lower face fullness is muscle-driven (not fat or skin) and you already have a history of responding well to masseter Botox, then:

low-to-moderate dosing
gradual treatment
and symmetry-focused adjustments

can create refinement without destabilizing the jawline.

The key is not over-reducing the muscle too quickly, especially after weight loss.

3. Jawline filler disagreement (why opinions differ)

The difference between your two consults is very understandable.

Earlier, when you were heavier: jawline filler may have been suggested to define structure through thicker soft tissue
Now, after weight loss: your natural jawline definition is already improved, so additional filler may be unnecessary or even counterproductive

In many post-weight-loss faces, the priority shifts from “adding structure” to preserving natural definition while restoring mid-face support.

4. Acne scars + subcision + lasers (diminishing returns phase)

You are also very accurate in recognizing the concept of a “treatment plateau.”

After:

subcision candidates are exhausted
multiple fractional laser sessions (like Fraxel) have been done
and skin texture has improved overall

it is very common to reach diminishing returns, where:

scars soften but don’t fully resolve further
additional aggressive treatments give smaller incremental gains

Subcision can still help if there are true tethered scars, but it becomes more selective rather than blanket treatment.

At this stage, improvement is usually:

subtle refinement
blending of texture
not dramatic change

This is important for expectation alignment.

5. Facial hair removal + folliculitis concern

Laser hair removal can sometimes temporarily worsen:

follicular inflammation
acne-like bumps
or irritant folliculitis

especially if the skin barrier is already sensitive from resurfacing procedures. This is more of a skin management issue rather than a contraindication, but timing between treatments matters a lot.

Putting it all together (most important part)

Your face is now in a post-weight-loss rebalancing phase, which typically means:

Mid-face: needs support restoration (cheeks/chin filler)
Lower face: needs very conservative muscle modulation (masseter Botox/Xeomin if indicated)
Skin: needs maintenance rather than aggressive resurfacing cycles

The biggest risk in your situation is not doing too little—it’s doing too much in multiple categories at once and losing natural balance.

Bottom line
Cheek + chin filler: appropriate and structurally sound when done conservatively
Masseter Botox/Xeomin: reasonable, but should be gentle and gradual post-weight-loss to avoid lower-face hollowing or jowl visibility
Jawline filler: likely less necessary now than before
Acne scars: likely in a refinement stage rather than major correction stage

The overall goal here is not transformation anymore—it’s reconstruction of balance after a major body change while preserving natural proportions and long-term facial stability.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  From the descriptions of your concerns you are likely to have the best results from a combination of treatments.  The Botox and filler plan seems it would address your concerns. Other treatments such as Morpheus8 can help address skin tone and texture.  It's also recommended to begin a great skin care routine using medical grade skin care products like Transform MD and wearing sunscreen every day.

100 pound weight loss - Cheeks/chin filler, masseter reduction, and acne scar treatment?

Answers (2)

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