Sagging cheeks and lower face. Do I need a face lift? (photo)

As we age it is common to see the 'inverted triange'. In youth, the upper face is wider and as we age the lower jaw region becomes wider. You are a beautiful young woman and therefore have multiple options. You could consider filler, fat transfer, skin tightening devices or surgery. The deep plane facelift is the best way to rejuvenate both the mid face and the lower face as well as the neck.

A mini lift with a deep plane SMAS release would lift your cheeks and correct deep nasolabial lines and perioral lines with limited incisions.

Thank you for your question. Based on what you’ve described—volume descent in the midface and heaviness in the lower third, but without signs of sagging in the upper face—a full facelift may not be necessary.
In cases like yours, where the goal is a more heart-shaped facial contour and the changes are mostly limited to the cheeks and lower face, the least invasive and most targeted surgical option is often an endoscopic midface lift.
This technique repositions the mid-cheek fat pads vertically, improves the nasolabial region, and helps restore facial balance—without the need for traditional facelift incisions. Compared to a “ponytail lift,” which primarily affects the upper face and temples, a midface lift directly addresses the area that’s most responsible for the concern you’ve described.
A full facial evaluation would help confirm whether this is the best approach for your anatomy and goals.
Warm regards,Op. Dr. Güray YeşiladalıBoard-Certified Plastic Surgeon

Hello,
There are numerous surgical and non-surgical options available, and determining the most appropriate approach depends on individual factors such as facial volume, skeletal structure, and chin anatomy. For patients with minimal skin laxity, I often prefer a minimally invasive technique utilizing endoscopic access with well-concealed incisions within the hairline. This approach allows for effective rejuvenation with limited scarring and a shorter recovery period.

Based off your photos - you have some midface decent (as we all do when we age) - this can potentially be re-lifted with a midface lift (can be done minimally or endoscopic through temporal incisions. Some fat grafting to the malar region (cheek area) can really help rejuvenate this area. (A traditional facelift is likely unnecessary at this point.)

The best approach depends on the degree of sagging, skin elasticity, fat distribution, and bone structure. Some common factors contributing to a widened lower face include:
✔ Loss of skin elasticity and collagen over time✔ Descent of facial fat pads✔ Loss of jawline definition✔ Excess fat accumulation in the lower face
As the cheeks sag and the lower face widens, the face may appear more oval or square rather than heart-shaped. To restore a heart-shaped appearance, the cheeks need to be repositioned, and the jawline should be refined.
There are three main procedures that can help achieve this:
1️⃣ Ponytail Lift – For mild sagging

In younger patients with sagging cheeks, I would offer first Sofwave nonsurgical skin tightening device. A cheek lift or mini-facelift will lift and restore cheek contour and enhance overall facial shape. Additionally, the jawline gets more defined.

To provide you with the most accurate recommendation, a physical examination would be necessary. Upon reviewing the photos you provided, there is noticeable sagging and volume loss, particularly in the lower face (chin and neck area). These changes may sometimes be considered signs of accelerated aging. To address this concern, I would recommend a mid facelift procedure. A mid facelift will help lift and tighten the cheekbones, chin line, and lower face, giving you a more youthful appearance. Additionally, the SMAS (Superficial Musculoaponeurotic System) technique targets the deeper structures of the face, such as muscles and connective tissue, providing more permanent and natural results. This technique effectively addresses sagging in the lower face and offers long-lasting rejuvenation.

Hello @alexa_bil97, thank you for your question. You are likely too young to consider a Facelift. Before considering such an invasive procedure, it's important to explore the non-surgical options available to you. Non-surgical treatments such as Morpheus 8 or Ultherapy use radiofrequency energy and Microfocused Ultrasound which helps stimulate collagen production in the skin and ultimately provides improvement of structural features like sagging checks, jowl or marionette lines. These procedures also don’t typically involve any fat loss. Be sure to talk openly with your doctor about all treatment options available so that together you can decide what will work best and make a non surgical protocol according to your goals and needs! Best wishes!

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

You have a very youthful appearance with excellent facial/neck contour. Some judicious use of fillers to accent the upper portion of your face may help you obtain the facial shape you seek. A mini facelift can also help shape your face but this seems to be too aggressive at this stage. The same applies to a full facelift.