Best Options for Sagging and Droopy Face?

A lot of plastic surgeons will address the soft tissues of the face, however few go to the extent of performing bone reshaping of the face. In someone as young as you, I would prefer the latter after addressing the issues at hand. We often forget the proportion of the face and by evaluating the picture provided, it seems that you may have a very long mid face. The face can be divided into thirds in a vertical fashion and the length of your mid face makes your cheeks look descended. So the problem may not be the soft tissue rather the bone structure. You also have a long forehead and this too throws off the proportions some. I would be weary of addressing the soft tissue with any lifting or facelift techniques until the bone is addressed and worked up using imaging. I personally don't do these procedures however I would not operate on someone like you until I consulted with a orthognathic surgeon who may recommend a maxillary impaction, which would decrease the length of your mid face. The brow asymmetry could be treated with a simple botox treatment or a contralateral brow lift depending on physical exam findings and treatment of the other things mentioned first. Hope this helps. Unfortunately not an easy answer.

There are several aspects that you have raised which can be addressed both with surgery and with non-surgical options. Although the eyes are covered, the photo suggests that difference in eyebrow position is driven by the difference in position of the eye sockets. This would not be changes by a brow-lift. Before considering a brow-lift a botulinum toxin treatment may help you to understand whether the higher position of the right eyebrow doesn't make  the relationship with the right eye appear imbalanced. The facial volumes can be altered by filling or tension. A good way to evaluate your preferred course of action would be to use 3D imaging and simulation before committing to a particular treatment. Skin tightening is an unusual approach at the age of 25, and careful visual planning would help the decision process.

Thank you for your question!  FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime. Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert. Best, Dr. Emer

Sagging of the facial skin and underlying tissue over ligaments attaching the skin to the bones can cause a droopy face even in the mid 20s and 30s. They can never be corrected by just filling the face with fillers. There are various types of facelift procedures that can be helpful to different age groups. A mini-facelift working on SMAS and minimal scar can help a young patient with lower face sagging (early jowls) however an older patient with sagging of the brows, midface and neck would require a full face and necklift. A proper facelift procedure involving pulling the SMAS should be performed for best results. I personally in many among other techniques use the composite facelift technique where a SMAS flap is elevated with minimal skin dissection, a very quick recovery and very long lasting result. This can be narrowed to a mini-facelift with even less skin dissection and shorter operating time (ideal for younger patients). Some parts can also be filled with fat grafting (Lift & Fill) to enhance to overall result and make you look even younger. Reduction of your buccal fat also through the same approach will help you get a nice and tight "nefertiti" result.
There is no age limit for facelift surgery. What is important is deformity the patient has and his/her expectations. It is usually easier and safer to perform surgery on a younger patient. In general I advice my young patients to undergo preventative care procedures. These include regular botox injections, fat grafting if a depletion in volume is starting to occur and superficial skin tightening procedures that DO NOT damage the underlying tissue (such as needle RF). While these procedures usually make the younger patient looking for facial rejuvenation happy, not all will be satisfied if the deformities are severe (regardless of age). As a rule of thumb, if there is sagging of tissues and excess skin, a facelift operation is inevitable!
Hope this helps,
Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

I am generally against the idea of disguising volume loss by removing more volume (such as a buccal fat pad removal). Buccal fat removal is appropriate for some patients, but based on the photo provided, adding volume to the upper cheek area would probably be most helpful. This can be done with injectable fillers, fat transfer, and even cheek implants. I do not think any type of facelifting procedure is indicated.Be sure to see an expert who can review all of the surgical and non-surgical options with you in detail.All the best,

Hi,
You are a great candidate for in-office fat grafting or filler. I would not advise a mid-face lift or buccal fat pad excision to address the concerns you mentioned. I encourage you to seek out a surgeon who is highly trained specifically in aesthetic plastic surgery, and someone who you feel comfortable taking care of you throughout the pre and post procedure period. Thank you very much for your question. 
Mark G. Albert, M.D.
NYC Aesthetic Plastic Surgeon

During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. It is possible to #combine #surgeries. In fact, I commonly recommend other procedures to go accompany a facelift, such as blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result. The best procedure approach will be discussed in greater detail during your one-on-one #consultation. I invite you to visit PacificCenterPlasticSurgery.com to view a complete list of surgeries commonly performed. 

If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives. It is extremely important to seek a board certified plastic surgeon highly trained with your desired procedures. I also encourage you to look at before and after photos of the surgeons actual patients. Also, reading patient reviews of those who have had combined surgeries will be beneficial. Gathering all of this information will help you make a well-informed decision.

All in all, I think it is premature to discuss facelift at your age.  I personally would stick with non-surgical methods of facial rejuvenation.  Fat transfer may assist you with adding volume to your cheeks.  In addition, soft tissue filler such as Juvederm, Voluma or Restylane can assit with covering up the jowl area and nasolabial folds.

Thank you for the photo. Naso labial folds become more prominent when patients lose volume in the mid face. I think you could get a very nice result by simply having fillers injected into your mid face and cheek area. This would give the appearance of a subtle mid face lift and reduce the appearance of naso labial folds. I suggest you try this before considering surgery.

A sagging or droopy face can be treated with Ultherapy as a non surgical option to reduce sagginess and lower face laxity. Our office specializes in surgical and non surgical facelift and necklift surgery. Raffy Karamanoukian MD FACS