26, female, sudden facial sagging. Is a facelift my only option? (Photos)

Question

Hello! I am 26 and unfortunately in the last year my face sagged down so fast (didn't lose any weight, don't smoke nor drink etc.) i became unrecognizable. I have now visible marionette lines, deep nasolabial folds and the fat loss in my face is so severe my eyebrows sagged down along with the eyelids and i can't do eyeliner like i used to a year ago anymore. I really want to look normal for my age but i don't know which procedure would be best

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs. Unfortunately, sometimes facial shape changes can be abrupt, and there is no clarity why this happens. On occasion, stress can be a contributor to rapid changes in the facial volume and expression.
As far as the changes that you are describing and the degree of reversal that remains compatible with your age and discreet, it is possible to consider non-surgical treatment like botulinum toxin to assist with the position of the eyebrows and injectable fillers can assist with mid-face volume enhancement. 
The images suggest that the buccal fat mobility has increased, and if you have noticed a lower position for the eyebrows, the expression around the eyes is also impacted upon.
Surgical interventions that can produce a visible impact but without leaving scars that are truly inappropriate in someone your age would include:
- Endoscopic-assisted brow lift for the eyebrow position
- Buccal fat reduction to decrease some of the volume in the lower part of the cheeks and along the jawline
- The buccal fat volume that is reduced can be reinjected in the front of the cheek
The impact that it has, is that it replaces a facial volume that is mobile and changes significantly with the change in position with a more stable positioning for this volume.

Mihail Climov, MD · Answer

Hello, and thank you for sharing your concerns. I understand how distressing it can feel when you notice changes in your face that seem to happen quickly, especially at a young age.
First, I would like to ask a few questions that can help us better understand what may be contributing to these changes. Have you experienced any recent significant weight loss (for example, more than 20 pounds) over the past year? Rapid weight loss can sometimes lead to facial volume loss and changes in skin support that may make folds and sagging appear more noticeable.
At 26 years old, I typically do not recommend a facelift. Facelift surgery is designed to address structural aging that usually occurs later in life, and in younger patients we usually focus on restoring volume and stimulating collagen rather than surgically lifting the tissues.
For someone your age, several non-surgical options may provide a much more appropriate and natural solution:
• Strategic dermal fillers to restore lost facial volume and soften nasolabial folds or marionette lines• Facial threads, which can provide subtle lifting and support of the midface and brows• Collagen-stimulating treatments such as Sculptra, which gradually rebuild your own collagen and improve facial structure over time• Optimizing nutrition, particularly adequate protein intake, which plays an important role in maintaining skin quality and facial tissue support
In many cases, a combination approach works best to restore youthful contours while keeping the face natural.
The most important step would be a proper in-person consultation, where we can evaluate your facial structure, skin quality, and areas of volume loss. From there we can design a plan tailored specifically to you.
You are very young, and with the right approach we can usually achieve beautiful, natural rejuvenation without surgery.
&mdash; Dr. Mihail ClimovYour Aesthetic Edge | Houston, TX

Phuc Dinh, MD · Answer

Hello, I am Dr. Phuc Dinh, a Board-Certified Plastic Surgeon specializing in comprehensive facial rejuvenation. Thank you for sharing your photos and your concerns. I understand how distressing it can be when you feel your face is changing rapidly.First and foremost, please be completely reassured that at 26 years old, you absolutely do not need a surgical facelift. True facial sagging that requires a facelift involves the stretching of deep retaining ligaments and the SMAS layer, which does not biologically occur in our twenties.What you are describing, the sudden appearance of marionette lines, deepening nasolabial folds, and the sensation of your brows and eyelids sagging, is almost certainly caused by localized volume loss in your mid-face, rather than true structural laxity. When we lose fat in the cheek area, the loss of structural support causes the surrounding tissues to shift downward and forward, creating shadows and folds around the mouth.I strongly recommend avoiding aggressive surgical interventions like a facelift. Instead, I advise seeking an in-person consultation with a board-certified plastic surgeon. The most appropriate path for your presentation is likely restoring that lost mid-face volume, either through strategic, structural dermal fillers or conservative micro-fat grafting. By replacing the support in your mid-face, you will naturally soften those nasolabial folds and restore a youthful, rested balance to your face.Best of luck on your aesthetic journey.
Dr.Phuc Dinh

26, female, sudden facial sagging. Is a facelift my only option? (Photos)

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