Why does my face look saggy under my eyes, around my nose and making my laugh lines more visible? I'm only 24 years old (photo)

Question

My face used to be rounder but then I got the botox in the masseter muscles so my face isn't so round which I'm happy with but around my nose and under my eyes my face seems to be sagging. I lost weight so I'm wondering if that's what caused it. It can't be the Botox right? Because that was back in Dec 2016. What would you recommend to fix the sagginess? It's making my laugh lines more visible as well. Especially my left side.

John Tang, MD · Answer

Thanks for your question.  The Botox placed in the massenter muscle is not the reason why the face appears "saggy."  The areas that you are concerned are caused by a loss of volume underneath the eye (tear troughs) and the laugh lines.  This is caused by the weight loss, sun exposure, genetics, and aging (even at 24!).  I would recommend that you consider a dermal filler to restore the volume loss.  I would start out with Restylane to fill the eyes and use the remainder for the rest of the area.  You will need 1-2 syringes.  Good luck!

Michael P. Morrissette, DDS, FACS · Answer

Thank you for your question and you have beautiful eyes. In some people, the area of the cheek below the eyes is flat due to genetics. Treatment options to lift the tissue include fillers which are temporary, or silicone cheek implants which are permanent. This is a very common area of complaint for many patients.

Harold J. Kaplan, MD · Answer

Hi Joanna.  You may have pointed out the main culprit when you mentioned the weight loss.  Losing weight very often causes the skin in the facial area to appear looser.  The upper area is pointing to something called the nasojugal groove and this can become more visible as we age.  A small amount of dermal fillers suchas Restylane, Lyft or Radiesse would really help you hide the concerns you are pointing out.  To see examples of before and after photos from our Orange County office, click on the link below.

Kenneth D. Steinsapir, MD · Answer

A small amount of Restylane would make a very nice difference here and last over a year.  You have profound upper eyelid ptosis and I think you would benefit from having this surgically addressed.

Jason Emer, MD · Answer

It is unlikely this is from your Botox treatment, but can be a result of the weight loss. Volume of the face can be improved with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Gabriel Chiu, DO · Answer

Thank you for your question. The Botox to your masseter muscles are not related to the hollowing and sagging that you are describing. Your weight loss is more likely the cause as it has resulted in your cheek fat pads shrinking.  Additionally, if you lay out to tan, use tanning beds, or spend a lot of time driving, especially in sunny Orange County, CA, the UV exposure will further reduce the collagen in your skin.

Lawrence D. Chang, MD · Answer

Thank you for your question and picture. Losing weight can cause changes to your face. Botox injections in the masseter muscles wouldn’t affect the appearance around your nose or under eyes. Although you are young, you may be a candidate for filler to help with the volume loss to tear troughs and/or nasal labial folds.

Bryan Correa, MD · Answer

Botox is generally not a good product for treatment of the lower eyelid. Oftentimes a filler can lead to satisfactory results. I would discuss your concerns with a board certified plastic surgeon. Best.

Kristine Brecht, MD (license suspended) · Answer

First of all you have a beautiful face, but with weight loss comes sag to the face.
So unfair.
If you don't wish to gain weight, you can do fat transfer to the face for full correction or some of the more temporary fillers for partial correction.
Dr Kristine Brecht
Seattle, Wa

Justin Harper, MD - Account Suspended · Answer

Hi Joanna,You are young but there are some factors that can contribute to early wrinkles and loss of fat/volume in the tear trough and nasolabial fold areas. Genetics play a huge role and so does sun damage. Botox is not just a wrinkle relaxer - it is also a preventative measure to prevent new lines from forming and established ones from worsening.Fillers in your case can be injected in layers. The denser ones like Voluma can be injected deeper to provide volume. As it pushes the skin from within, it also creates a lift so that the troughs and folds are less evident. Both Juvederm and Restylane have created versatile and more specialized fillers that are longer lasting and more suitable (e.g. spread and density).The troughs can be injected with either Restylane Refyne or Volbella. The effects are immediate. You will be thrilled at the remarkable change. If you need more lift on the nasolabial fold, fillers can be injected medial to it.All the best,Justin Harper, M.D.

Why does my face look saggy under my eyes, around my nose and making my laugh lines more visible? I'm only 24 years old (photo)

Answers (10)

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