Sagging cheeks with folds and nasolabial lines since I was a teenager - current age 28 (Photo)

Question

Hi I am 28 years old and look pretty young except I have always had large cheeks that droop down. This has been the case since I was young (teenager). I have strong nasolabial folds and mid cheek folds. I am not too concerned about any other part of my face (undereyes, nose, chin etc). I was considering a cheek lift. Alternately will a radiesse filler migrate or pull my cheeks down further? Will restylane or some other hylauronic filler work?

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

Fereydoon S. Mahjouri, MD · Answer

Your cheek fat pads have descended medially and downward. One option is a mini cheek lift with a minimal incision. Thread lift will  also address your concerns for few years. The none invasive procedure is injection of Scalptra or Bella fill lasting a lot longer than other HA injectionables.

William Portuese, MD · Answer

The photographs demonstrate a flat maxilla and a flat cheek profile. Fillers offer a temporary augmentation to the cheeks, while cheek implants offer a permanent solution. Cheek implants are usually placed through intra-oral approach under a brief general anesthesia as an outpatient procedure. Cheek implants are manufactured in a large assortment of both sizes and shapes which is best determined at the time of the examination. For many examples of  cheek implants, please see the link and the video below

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

Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  From the photos, your cheeks are very flat in the front, there is excess fat in the lower face and chin is weak as are the back portions of the jaw line.  These combine to create an elongated, oval shaped face. Sagging cheek tissues in a 20 year old typically indicate a lack of cheek bone support underneath.  The "goal" should be to create an aesthetic shape to the cheek by adding precise volume to the front portion of the cheeks.  In contrast, "jowls" as described below are the main indication for any type of facelift.  Your face has no evidence of jowls and as such you would not be a candidate for any type of lift.  In fact, you can see how lifting the cheeks tissues up and back as you are doing in one of the photos, actually makes your mid face and cheeks even more flat.   
 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.  Liposuction would be added to reduce excess fat and further shape the cheeks and lower face.
 I have performed many Chin Augmentations using chin implants for over 30 years.  From the photos, your chin is weak.  A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin and "pseudo-jowls".   Pseudo jowls differ from "jowls" in what causes them, what they represent and how they are best treated.  Pseudo jowls are defined by a fold of tissue laxity that goes from the corners of the mouth to approximately 1/3 or 1/2 the distance to the lower jaw line.  It’s caused by a weak chin and its lack of tissue support around the chin and mouth area.  It's best treated by correcting of the weak chin with a silastic chin implant.  Jowls are described below in greater detail.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. 
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.
 The back portion of your jaw line is a bit weak and can be augmented, without making your face appear masculine, using precise placement of a dermal filler (I prefer using Restylane Lyft).  
  "Jowls” are sagging facial tissues in the lower face and remain the primary 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 SMAS facelift is the minimally invasive, short incision SMAS 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.
Hope this helps.

Sagging cheeks with folds and nasolabial lines since I was a teenager - current age 28 (Photo)

Answers (4)

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