Skin sagging or volume loss? Plus pronounced nasolabial folds and perioral mounds (photos)

Hello,
Based on your weight loss history and your pictures, sagging the lower face is the major part of problem. Best option is a good Profound RF treatnment done by an experienced Practitioner and waiting for at least 6 months to see the final result ( lifting and thightening of lower face ).

Best regards,
Dr Ali Sajjadian

From the photos, there appears to be significant chin recession that can be easily addressed with the use of a robust HA voluminzing filler that can yield immediate, on-the-spot results, and engender little to no significant downtime. Appropriately injected HA lifting filler for the upper, outer cheeks will likely contour a more feminine, oval, heart-shaped face and diminish the smile lines, as well. You would be surprised how fast you can have the effects you seek without having the expense or downtime of going under the knife. These are filler techniques that those of us in the field practically perform every single day of practice. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injector. In experienced hands, the chin and the cheeks can be done in under a half hour with immediate results that typically yield a "Wow!" response. Hope this helps and best of luck.

At age 23, you do not have loose skin. Your side profile photographs demonstrate a recessive chin, because your mandible bone never grew far enough forward. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions. Placement of a chin implant can be done under local anesthesia as an outpatient procedure, which takes about a half an hour.