Age 39, non surgical options for sagging face? (Photos)

Question

I'm 39, athletic with a stable weight. Slowly lost 20 pounds over the last 3 years. I'd like a tighter and more lifted look to my face, especially my sagging cheeks, nasolabial folds, and beginning marionette lines. Imagine placing your fingers by the cheekbones and slightly pulling up. I want to avoid thread lifts. Is surgery the only option? I'm open for creative solutions such as a chin implant, buccal fat removal, RF microneedling etc.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jeffrey S. Rosenthal, MD · Answer

Laxity along the jawline is common.  There are non-surgical procedures available to improve the jawline and neck.  Endolift Laser is a remarkable procedure using a fiber placed beneath the skin to tighten skin and smooth out fat.  This in conjunction with PDO threads to reposition fallen tissue and stimulate collagen are ideal.  These procedures are office procedures with minimal down time.  These are ideal for those with moderate laxity of the face and neck.

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

A.J. Amadi, MD · Answer

Hello-First, congratulations on your weight loss! If you want to stick with non-surgical options; dermal fillers and RF microneedling are your best options. There are a variety of dermal fillers that can be used to help with facial re-balancing, contouring and volume depletion. Radiofrequency/microneedling can be helpful to tighten skin and improve laxity.

Chin implants and buccal fat removal are options but are surgical options. Determining whether you are open to surgical options would be a first step in deciding what type of consultation (surgery vs non-surgical) would be appropriate. Good Luck!

Paul Flashner, MD · Answer

Thank you for your pictures. I would recommend Morpheus8 treatments to stimulate your own collagen and elasticity. If you use filler in the cheek area to help lift the heaviness around the mouth as well as using filler in the marionette lines to smooth the areas some more, you should be happy with the results. Good luck!

Michael I. Echavez, MD · Answer

There are several non-surgical options that could help improve sagging of the face.  I would say that one of the better options would be FaceTite.  This is a procedure which delivers heat (using radio frequency) to the layers under the skin and this can produce tightening along the jawline and to the lower face.  RF micro needling could be done in addition to FaceTite, as this can produce some skin tightening externally.

Nelson Lee Novick, MD · Answer

No, facelift surgery and surgical chin implants happily aren't the only options these days, and, actually haven't been so for quite a few years already--ever since we learned that volume loss and deficits in the face are responsible for so much of facial sagging and folding, such as smile lines, jowls along the jawline, marionette lines, etc. A robust HA liftting filler placed properly in the cheeks by an experienced injector would not only recontour and lift the cheeks, but improve the under eye regions, as well. A more resilient HA placed properly around the angles of the mouth would help to straighten the angles of the mouth and treat the marionette lines. Another robust HA filler injected properly in the chin can help not only to harmonize the projection of the chin with those of the lips and the nose in profile view and secondarily better define the whole jawline. And all this can done in one treatment session of about thirty minutes or so, if so desired, with results seen on-the-spot and with little to no signficant downtime. So, no creative solutions needed. Just make sure that you consult with an experienced, board certified cosmetic dermatologist and be very cautious when evaluating the claims for this or that fancy, expensive light or energy-based gizmos whose hard science to promote their use lags woefully behind the hard science to back them up, or even when evaluating expensive, invasive surgeries that entail significant post-treatment downtime. Best of luck .

Nuket Eroglu, MD · Answer

Hello, I carefully examined your face. You have some laxity and sagging, but there is no skin gathering in front of the ears. Therefore, please don't consider a facelift surgery. You are still very young; 20 is too early for facial procedures. You don't need such surgery. I would like to suggest non-surgical treatments that will improve your skin quality and make your face appear tighter. Liquid facelift procedures, which I refer to as non-surgical facelifts, sharpen the jaw contour and give your face a tight and youthful appearance. Radiesse is a special calcium hydroxyapatite molecule that I frequently use, stimulating fibroblasts and increasing collagen, providing a natural lifting effect on the face. Radiesse offers both a filling effect and facial lifting. Based on my assessment of your photos, your mid-face particularly needs attention. You will be very satisfied with Radiesse as it stimulates collagen for many years, gradually making you look younger and tighter. Additionally, I recommend Thermage FLX for you. Thermage FLX is a radiofrequency treatment that can maintain the skin surface at 20° while reaching 80° under the skin. It's a one-time application with long-lasting effects. It is the top-ranked non-surgical facelift treatment globally, relying on superior technology. By examining the results, we see that the effect starts immediately, continues to improve over six months, and then lasts for many years. It's also approved for enhancing jaw contour. I confidently recommend it.

Camille Cash, MD · Answer

You may want to consider FaceTite.  This minimally invasive procedure uses RF technology to tighten the skin.  This is safe for the face, neck, and under eye area.  Results can be enhanced by adding Morpheus8 treatments.  See an expert provider near you to learn more.

Glenn Vallecillos, MD, FACS · Answer

REMEMBER: Always take your time deciding on who will be your provider and on what treatment you end up getting. That means talking extensively with potential providers and getting consultations until you feel completely safe and secure with your final decision.

From the photos it seems like you take good care of your skin. Having a legitimate skincare routine is step no.1 when considering any aesthetic treatment; invasive or non-invasive.

When it comes to your concerns of "my sagging cheeks, nasolabial folds, and beginning marionette lines" and achieving a "tighter and more lifted look":

Buccal fat removal would make your face less rounded and give it that "pulled" look you're going for. But the best results would be achieved with buccal fat removal in conjunction with RFAL's such as Fraxel (for skin quality and texture) and Morpheus 8 (for skin tightness and tone). If you're really serious, you may also want to consider FaceTite and Renuvion J Plasma on your face, because this will drastically tighten your skin from the inner-layers of the skin, but it's not as common for practices to have as Fraxel and Morpheus 8. Fraxel and Morpheus 8 are much more less invasive than Renuvion J Plasma and FaceTite.

Filler and botox is an option for a lift effect but this will only be achieved with an experienced injector who was able to produce your desired results before (it's essential that you see as many before and afters as possible if you decide to take this route).