What can I do about prematurely sagging cheeks and jowls? I am 34 but my face suddenly appears much older.

Question

I have always had a round/full face despite being my ideal weight, so it seems like I should avoid fillers of any sort. To add Botox seems like going from one problem (sagging) to another (a chubby-looking face). In the past year my face has started looking tired, and if I catch a glimpse of myself in the mirror, I always look like I’m frowning/mad. Do I have options other than a facelift at 34?!

Alexander Rivkin, MD · Answer

Hello and thank you for your question.  Based on your photos, I have a couple of suggestions to help improve the sagging skin you are concerned about.  There are a slew of skin tightening treatments out there that all essentially do the same thing: deliver heat to the deep layers of the skin where collagen and fibrous tissue lie, to stimulate production of more collagen and tighten what's existing.  Different energy-based treatments use different modalities to achieve this and some are more successful at doing so than others.  The newest and most effective (in my opinion) treatment today is the Profound treatment.  There is a bit of downtime after the treatment, such as swelling, redness and some flaking of the skin, and once all is healed there will be continuous improvement for up to 6 months after the treatment.  A second suggestion I have for you is to add fillers to your pre-jowl sulcus, cheeks and pre-auricular areas, as those are the areas of your face that seem to be losing volume (fat tissue) the most. As we age, we lose volume in different pockets of the face, and not all at the same rate.  When fillers are placed properly and strategically, to replace this volume loss, there can be significant improvement in the look of your sagging skin. Keep in mind that combining the two treatments I have suggested will give you the best results, as your case is due to not only the volume loss I explained in the ladder suggestion, but also the laxity within your skin's matrix that will be improved with a skin tightening treatment.  Be sure to seek an experienced practitioner who specializes in facial aesthetics for best results.  Good luck!

Jeffrey S. Rosenthal, MD · Answer

Aging is a gradual process with loss of skin elasticity. Tissues of the face descend over time.
The Endolift Laser is a remarkable laser using a fiber beneath the skin to stimulate collagen, tighten skin and smooth out fat.  When combined with PDO threads the results are best.

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

E. Jacob Simhaee, MD, FACOG · Answer

Dear concerned patient.
I would suggest you look into Y lift for the upper or both upper and lower of the face if needed.
Please make sure your doctor has been trained by the original doctor who came out with this technique.
his name is Dr. Trokel

William Groff, DO · Answer

Thanks for your question and photo. While there are many options for you to consider, I believe a Silhouette Lift might give you the best outcome. This minimally-invasive procedure is performed in our office using local anesthesia. Sutures are inserted beneath the skin, where they lift tissue to a more youthful position and smooth the outer skin layers for a firmer, rejuvenated appearance. Although the sutures dissolve over time, they promote collagen production by the body that enhances and extends your positive results. Choose a board-certified cosmetic dermatologist with extensive experience in this treatment to ensure an optimal outcome.

Jason Emer, MD · Answer

A combination approach would give the most improvement. Sagging cheeks and deep wrinkles can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, radiofrequency treatments, lasers (Fraxel, Clear + Brilliant, CO2), microneedling/PRP, salt facials, and Cosmelan for skin tightening and to improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Muhammad Mirza, MD (license suspended) · Answer

Thank you for your question. Fillers like Juvederm are a good option for lifting the jowls.  You may consider combining fillers with a thread lift for optimal results. Ultimately you will need a to schedule a consultation with a reputable doctor to determine the best treatment option for you.  Best regards

Douglas Wu, MD · Answer

To remedy a sagging face, the most immediate and dramatic nonsurgical intervention is Silhouette threadlifts. They lift your face and also stimulate the production of new collagen so that your skin then can support itself in a more upward position. Fillers like Voluma wouldn’t make your face look wider, but could build up your cheekbones to create more lift. You may also have dry or inelastic skin that can be improved with skin rejuvenation treatments such as ThermiTight, Ultherapy, and lasers that stimulate collagen remodeling. Consulting with a board-certified dermatologist will get you the specific answers you need.

Camille Cash, MD · Answer

From your photo it appears you will have the best result from a combination of treatments.  Botox and fillers can address wrinkles and deeper lines.  Treatments such as FaceTite and Morpheus8 can tighten skin and improve overall skin tone and texture.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Pradnya Apte, BDS · Answer

From your images alone it is
very difficult to get a full sense of your concerns, however, given what you have
described I wonder if you had considered non-surgical Silhouette Soft?
Silhouette Soft is a thread lift treatment that lifts sagging areas of skin in
the midface, jawline and neck. The treatment is of course bespoke to your
particular concerns.   It is not a
surgical facelift, instead the face is numbed and absorbable sutures are
inserted beneath the skin, and when tightened these lift the skin, giving an
immediate, and natural looking result. It is what one could describe as a soft
tissue reposition. The sutures are absorbed over time, and stimulate the body
to create collagen, enhancing the result still further. Given your age and the
image you have shared; I would suspect you would achieve a very pleasing
result.

What can I do about prematurely sagging cheeks and jowls? I am 34 but my face suddenly appears much older.

Answers (13)

More Nonsurgical Facelift Questions

Is HIFU good or bad for the face?

How to tighten or contour lower face? (photos)

How much and what type filler is recommended for a lateral brow lift?

Can I combine face fillers and ultrasound therapy to achieve a firmer lifted face and to reduce wrinkles?

I am curious as the "LDI" treatment that is advertised for sagging skin vs. a face lift or a "lifestyle lift".

WE SEND PRETTY
EMAILS