My face has really began to sag and just look tired. What will be best for my sagging jowls and under eyes? (Photo)

Question

I really hate my jowls I feel like they are pulling my whole face down. I purchased a botox packages thinking I need my Masseter muscles injected but after further research I think I may be wrong. I think I may need fillers in my cheeks and under my eyes instead. with this help my sagging jowls that look like they are just pulling my whole face down and blend right into my neck. I have a bad ice chewing habit that I think helped contribute to this and I am currently trying to break it.

Nima Shemirani, MD · Answer

Hi @jackspot. Thank you for sharing your photos. I recommend a combination of dermal fillers and a skin tightening procedure like Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

David Hansen, MD · Answer

Liposuction of the jawline/neck/jowls will give the biggest improvement and is so easy to undergo. You can drive yourself home and be back to work in 1 day.

Brian Maloney, MD, FACS · Answer

Fillers under the eyes and in the cheek can help soften the tiredness and lift the cheek. You dentist will be glad to hear you are beating the ice chewing habit!! You could consider Sculptra, or a hyaluronic acid filler to help define the jaw line where you are beginning to loose some structure, especially at the back of the jaw and corner of the mouth.  Regarding treatment of the jowls and neck, there are several options; facial liposuction alone, facial liposuction with thermi RF, or a facelift. I would suggest consulting with a couple plastic surgeons that specialize in the face to determine which options may be most appropriate for you.

Jason Emer, MD · Answer

you really need a combination of fillers, lasers and skin tightening. I suggest you see a facial sculpting expert to get you options for these treatments in combination or even surgical approaches.  Best, Dr. Emer.

Clifford Albert, MD · Answer

All treatments should be based on the 4 R's
Relax the wrinkle with botulinum toxin
Refill the line with a long term filler like Radiesse
Repave with lasers
Repair with surgery if you need to.
A combined approach is necessary.no single treatment does everything

Carmen Kavali, MD · Answer

Thank you for your question and for the helpful photos.  I do see your areas of concern, and here is how I would suggest addressing all of them:1.  Voluma or Lyft for midfacial volume restoration.  This will fill the cheeks and lift the lower face and nasolabial folds.  If you address the lower face without addressing the midface, you will appear unbalanced.2.  Restylane for undereye hollowing.3.  Consider Ulthera for skin tightening and lifting of the jawline, the brows, and the midface.4.  You do not appear to have hypertrophy of your masseters.  I would not inject Botox there.I hope this is helpful to you.  To your health and beauty,Dr. Kavali

Darryl J. Blinski, MD · Answer

Sounds like you do not desire facial surgeries? Which might be your best option>>>>>>>>>>>>>

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

Hi, signs of nasolabial folds and jowls are typically due to a lack of support in the anterior (in the front) section of the cheeks.  This lack of bony support allows premature sagging of facial tissues towards the nose and mouth creating the nasolabial folds and jowls.  If excess fat exists in the face, this adds weight for gravity to pull the sagging tissues at a greater rate.  Hi, I have performed facelifts for over 30 years.  From the photos your cheeks are very flat (concave) anteriorly (in the front), there is excess fat below and in front of the cheeks as well as under the chin and the chin is very weak which combine to create an elongated oval shaped face.  Following the beauty principles outlined in my book on face and body beauty, 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 shape the cheeks, chin and jaw line with every facelift procedure. If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation.  I have performed many Cheek Augmentations over the past 30 years and the notion that Cheek Implants or dermal fillers to the cheeks will lift tissues is an urban myth.  Filler to the cheeks or cheek implants will shape the cheeks but will not lift up the jowls.  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 and subperiosteal facelifts) but with these added benefits:very small incisionsminimal tissue dissection = less bruising and swelling = rapid recoverycan be performed in 90 minutes or less, with or without general anesthesiano incisions within the hair = no hair lossexcess fat can be removedexcess skin removedcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-opThe lower eyelids show some signs of excess fat in the medial fat pocket and there are "malar bags" in the cheek area.  The lower eyelid fat can be treated with a lower blepharoplasty but there are no permanent treatments for malar bags, just shaping of the cheek using a dermal filler that can also soften the malar bags.   Hope this helps.

My face has really began to sag and just look tired. What will be best for my sagging jowls and under eyes? (Photo)

Answers (8)

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