Best approach to minimize mid cheek groves and nasolabial folds for a 20 year old?

Question

I have very prominent mid cheek grooves (they´ve become noticeable over the past two years) and deepening nasolabial folds, creating quite a distinct ¨sagging¨aesthetic. Would a mini face lift be the best option, or cheek augmentation (structural fat grafting)? Would either of these options worsen the mid cheek grooves? What´s the most long-lasting way to correct nasolabial folds without worsening mid cheek grooves?

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Without photos, I cannot comment specifically on your case. It would be rare for a 20-year-old to have significant enough sagging and creasing to warrant a mini face lift (rhytidectomy). However, that may be the best solution in your case, if your skin quality is poor and you’ve lost muscle volume. Find a great facial plastic surgeon who can analyze your bone structure and skin and make recommendations to give you the improvement you want now, plus devise a long-term plan to help you stay youthful. I hope this helps.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question, however with examination face to face or photos its difficult what to advise. 20 is very young to be left with scars on your face.  Fillers maybe a good option.  Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.  All The Best

Robert M. Tornambe, MD · Answer

clarea96.   I don't think I need a physical exam or photos to tell you that you are too young to consider any type of facelift!  Fillers may be an option.  Be sure to consult with a board certified plastic surgeon. Good luck!

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek, chin, lips), liposuction and/or facelifts for over 30 years.  Non smiling photos of your face from the front and side would help in the evaluation.  Cheek grooves are an indication that the underlying front portion of the cheek bones are lacking volume and are flat or concave.  The lack of bony support allows tissues to sag towards the nose and mouth.  The more concave the front portion of the cheeks are, the earlier in life this tissue shift occurs.  This is different than "jowls" (the main indication for a facelift as described below) in the lower face which is very rare in a 20 year old.   
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.   I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  If you have "jowls” these are sagging facial tissues and the main 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, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
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 from the face and neck
excess skin removed from the face and neck
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.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

Best approach to minimize mid cheek groves and nasolabial folds for a 20 year old?

Answers (5)

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