Mid-face volume loss and sagging... In my 20s! (Photo)

Starting in my mid 20s, I noticed that I was losing volume in my mid face area. At 29 now, my cheeks now rest around my nose, creating a flat cheekbone area, deep nasolabial folds and droopy corners around my mouth (see photos). I have generally good features and don't want to mess with them and do more harm than good. What would you recommend to lift my cheeks and to reduce the mouth droopiness?

Doctor Answers 9

Cheek implants for midface volume loss

 Fillers for a temporary augmentation to give volume restoration to the mid-face over the cheeks and the maxilla. Results last and one to 2 years. For a permanent result, consider placement of cheek implants  for mid-face volume restoration. Cheek implants are composed of Silastic, are placed through an intra-oral incision directly over the maxilla to augment the cheek area. For more information and many examples, please see the link and the video below


Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Options for mid face volume

The most striking thing that I see on your photos is that you have indeed lost a substantial amount of volume in your mid face One of the guiding plastic surgery principles is to replace like with like if possible. Therefore in my opinion you are an excellent candidate for fat grafting to this area . This may be the only solution that you need. You may also need to have a cheek lift with an incision in the sideburn in front of the year and just around the ear lobe.  The only way to really tell is with a physical exam. Your best option is to see a board certified plastic surgeon who is experienced and facial plastic surgery as well as fat grafting. 

Andrew Kaczynski, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 108 reviews

Facelift surgery

Assuming adequate skeletal support a midface lift would help you.Facial rejuvenation surgery, believes that facelifts should make patients look younger rather than 'operated on' or 'different.'

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Mid-face volume loss and sagging

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants and facelifts over the past 30 years. Early signs of nasolabial folds and jowls are typically due to a lack of support in the anterior (front) section of the cheeks. This lack of bony support allows premature sagging of facial tissues towards the nose and mouth creating the nasolabial folds and jowls. From the photos your cheeks are flat anteriorly (in the front) and jowls are present. These factors combine to create a rectangular shaped face.
Following the beauty principles outlined in my book on face and body beauty, men look ruggedly handsome with angularity in the cheeks, chin and mandibular angles. 

"Jowls” are sagging facial tissues and an 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 facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most 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. You may opt to create more angularity in your face with the following procedures first to see if this gives you the results that you want before having a minimally, invasive facelift.

The following procedures would create a more ruggedly handsome face.

  • Cheek augmentation with cheek implants to add angularity to the cheeks and mid face. 
  • Augmentation of the mandibular angles using a dermal filler (jaw implants have too many unwanted side effects IMHO) to add volume, angularity and flare to the jaw line.
  • Possible Chin augmentation, using a chin implant, to add projection to the chin creating harmony and balance to the lower face. I suspect that the chin is a bit weak which can be confirmed with a proper profile view of the face and neck.
Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Midfacial Volume Loss

Thank you for sharing your question and photos. Volume loss is a very common cosmetic issue that can be easily address with dermal fillers. We have had success in our practice using Voluma and Restylane Lyft to restore mid face volume deficiency. Usually, adding volume to the mid face will also improve the appearance of the nasolabial folds you are bothered by. After fillers, if you still would like to improve the “sagging” you are noticing, I would recommend a non-surgical thread lift. Novathreads are an absorbable PDO suture that are inserted beneath the skin and lift the underlying tissue. This procedure is a great way to achieve a subtle lift while still looking natural. Given that you are on the younger side; it is important to ensure you still look age appropriate. I would recommend consulting with a board certified physician who will be able to discuss realistic outcomes of dermal fillers and Novathreads.

Kian Karimi, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Start with Voluma

Voluma is an excellent start.
Voluma will provide the volume and lift that you need.
It will give you an opportunity to see the results and start your facial rejuvenation.

Midface Lift

Dear MrNYC87,

The results you desire can be achieved with properly placed filler.  The results are pretty immediate and have little to no downtime. 

I would be happy to see you!

All the best,
Dr. Michelle Yagoda

Michelle R. Yagoda, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Treatment of mid-facial volume loss

Thanks for your question and your photos. Indeed, you do appear to have some loss of fat -- perhaps due to recent weight loss?

There are two avenues for treatment -- permanent implants (which involve surgery) or skin fillers, which have various amounts of longevity.

My personal recommendation would be with a long lasting skin filler such as Voluma or Sculptra.  They are different and work in different ways.

Best to speak with a plastic surgeon about the pros and cons of each method.

Elliot W. Jacobs, MD, FACS
New York City

A Nonsurgical Mid-Face Rejuvenation With A Volumizing Filler Works Well For Mid-Cheek Volume Loss

Your description accurately describes what I also see from the photos provided. Although it is somewhat premature, assuming you are in good health and there is no other underlying medical condition to explain this, I would have to agree that this degree of volume loss at this age may be a bit early, but by no means a rare occurrence. 

Fortunately, nowadays, this kind of problem can usually be easily and quickly treated in an office visit with volume repletion to the mid-face region--known as a nonsurgical mid-face rejuvenation. Voluma is my favorite volumizing filler for this purpose in my Upper East Side Manhattan office. Radiesse Plus is another choice. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt to use Stylage XXL and Emervel Volume for this purpose). Proper volumization of the mid-face will very likely secondarily improve the smile lines and marionette lines problem, and likely without needing to inject them directly. 

Be sure to seek consultation and treatment by a board certified aesthetic physician with experience and expertise in nonsurgical facial rejuvenation techniques. It is also important that you make certain that he/she has experience in injecting the male face; improper placement of volumizers can lead to inadvertent feminization of the male face. Be sure to ask to see his/her before and after photos.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.