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

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Hello mmyc Cheek implants are available in a range of different shapes and sizes, they are mostly customized to fit a specific facial structure. Fillers such as Juvederm Voluma, Radiesse and RestylaneLyft are great alternatives to cheek implants, also fat transfer or injection can be done.

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.

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.

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.'

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.

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

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, FACSNew York City

 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

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.