What to do about sagging asymmetrical face at a young age? (photos)

Question

I'm 30 but look 40 because of the saggy face,I lost a lot of weight in 8th grade, I gained weight but the face remained saggy & droopy eyes, looking old & tired. A surgeon told me I'm too young to get surgery & recommended sculptra, got 1 treatment, right more than left because of the asymmetry. I don't know if it made any difference, I feel the sagging skin looks fatter, didn't go for more treatments. I'm not sure what procedure to go for if any. Any advice? The pics are a year after sculptra.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Ava T. Shamban, MD · Answer

For volume loss in the midface,
     Voluma is one of the best options. It is more volumizing and last
     longer than most fillers. The results are immediate and it's a safe,
     dissolvable filler.

Nelson Lee Novick, MD · Answer

From the photos provided, it appears that there is loss of volume primarily in the mid-facial region. Such a loss of volume leads in turn to sagging of the lower portion of the face. A nonsurgical mid-face rejuvenation using Voluma XC (my choice in my Upper East Side Manhattan practice) or StylageXXL (my choice in my Israel satellite facility where a far greater number of regulatory agency approved fillers and volumizers are available) would not only help to re-inflate the mid-cheek areas, but secondarily lift and recontour the lower facial sagging. I would not, however, suggest augmenting the upper outer cheeks, as this can lead to an unwanted feminizing look.I am not a fan of Sculptra, since it is relatively expensive, does not give any immediate improvement, typically requires a series of two to three treatment sessions, and actually does not last much longer in this treatment region than the products mentioned above, which do in fact yield immediate "Wow!" results. Be sure to seek consultation an treatment by a board certified aesthetic physician with experience and expertise in nonsurgical cheek augmentation procedures. Make sure to ask to see his/her before and after photos.

What to do about sagging asymmetrical face at a young age? (photos)

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