What can be done about jowls in a 34 year old? (photos)

Question

I've always had a low-set chin (double chin) and larger protruding cheeks "jowls" since then was a little girl. I feel that it really distracts from an otherwise pleasant face. Both my parents have it, and as they've grown older, it's become very pronounced. I'm not at all over weight. Is 34 too young to have surgery? What kind of surgery would need to be done? A mini facelift? Would I need liposuction as well? What can be done with my facial anatomy to give me a more defined, sleek, jaw line?

Alejandro Nogueira, MD · Answer

Your jowls, double chin and overall soft-tissues flaccidity are due to poor skeletal development at the chin which, beeing ok in the horizontal width, is too small in the anterior projection and too short vertically; you are an optimal and undisputable case for a two-dimensional genioplasty with bone grafting supply (elbow or hip as donors). Never a chin implant may produce such two-dimensional effect or any soft-tissue re-stretching, besides the prosthesis at the chin are not only disappointing in their results but also lead to a series or complications making them outed sooner than later. Fillers are a total hazard for your health and beauty, will not even comment on them. Liposuction? what of? would be moneysuction only and very likely an irreversible deformity, there is no fat that can be extracted from your slim and youthful face.
Do research well and follow the advise of a well-trained surgeon with experience in osseous genioplasties, the results are awesome, safe and for a lifetime.
Better images are required to provide overal assessment of your case.
Feel free to request any additional information from me.

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Ron Soltero, MD, FACS · Answer

dear Patient: thanks for your question and your photos!  After 18 years performing Plastic Surgery and particularly Facial Plastic Surgery, there are two ways you can proceed to achieve your desired results.  You can start with Fillers, injecting Voluma (which is a more cohesive hyaluronic acid) for the cheeckbone area, this will help with improving your sagging in jowels. You could also try Kybella injections in your neck area, they are supposed to dissolve the fat in that area.If you want a more drastic change, You could have liposuction in your neck area, Buccal fat removal Fat Transfer to your cheeckbone and  a chin implant to balance your face and create a natural looking result.I would suggest you always consult with Board Certified Plastic Surgeons, and start with a non- surgical approach first.  I always advice my young patients to try out the fillers first, and if the outcome is not as they expect thy then can have more invasive surgery.  It is very important for you to let your surgeon know what are your exact expectations so the surgeon can match them with a possible outcome that is realistic.Hope this helps!!!!

Luis A. Vinas, MD · Answer

you are a great candidate for fillers. You can camouflage the Joel's by injecting in the front snd behind it to make it smooth. You csn Aldo augment the chin and the depressed cheeks for a mor balanced and youthful look. The other option is Ulthera pt or fractionated erbium to tighten the jowls. Thanks

Thomas Buonassisi, MD · Answer

Hello and thank you for your photos,
I do see patients in their 30s for facelift surgery but it certainly isn't the norm. Typically these patients have inherited certain facial features that contribute to them developing jowls and jaw line laxity at a young age. You are pretty and probably notice these features more than anyone else. Although you could consider surgery, there are some non surgical things you could consider as well:
Dermal fillers: project your chin a little more, which will give the illusion of a longer jawlineDermal fillers: fill the area just below your mouth, on either side of the chin, which will give the illusion of blending the jowl a littleSurgical options
Because you are young and appear to have good skin condition, you could consider a mini lift. There is a link below. The mini lift is a smaller type of facelift that has shorter incisions. Only an in person consultation would tell, but this procedure might be sufficient to tighten the jawline and jowls. Please keep in mind that the incisions are customized for the patient, depending on the goals.Chin implant, if you decide to go the surgical route, placing a small chin implant could improve the result of the mini facelift.All the best,
Dr. Buonassisi

Konstantin Vasyukevich, MD · Answer

Thank you for posting your photos.  I believe the best procedure to reverse the aging changes, that concern you, would be a face and neck lift.  It is certainly not common to be getting a facelift at 34; however, some people develop jowls and neck laxity at an early age (often runs in a family) and the only way to definitively improve the contour of the jawline and remove the sagging skin of the neck is to do a lift.  To further refine the jawline a buccal fat pad removal might also be considered in addition to a facelift.Best wishes!Dr. Konstantin

Paul J. Leahy, MD · Answer

Thanks for your question. I think at your young age, I would start by offering you Smartlipo (laser liposuction) of the neck area. I would expect this would help improve the contour of your neck, especially in profile view. We generally don't do liposuction of the jowl regions because of the risk of nerve injury. Mini facelifting procedures maybe something you consider 10 years down the road if it still bothers you? Best wishes.PS--below is a link to a video about the mini facelift that may be of interest to you?

Daniel B. Kim, MD · Answer

Thank you for reaching out and posting photos. Nothing can replace an in person consultation, they will be able to go over all types of options with you, both invasive and non invasive. From there you can decide which option will work best for you and give you the desired result. Be sure to visit experienced board certified sugeons. Best of luck! Dr. Kim

Myriam Loyo, MD · Answer

Hi there, thank you for your photos and questions. I think you should consider chin augmentation. You have a mildly weak chin and improving the position of the chin well help address the lines you are starting to see between the corner of your lips and the jawline. Check out the profile of the chin implant I have on realself and examine the jowl area. I offer complimentary liposuction of the neck with chin implants. Although your main problem is not excessive fat, it still helps.  Another very popular option right now for face contouring is buccal fat pad removal. It was very popular in 80s and feel out of favor due to premature aging and sagging (years after the procedure). The procedure has regained popularity again and patients are choosing to either remove half of the fat pad or understand they will likely need fillers of fat transfer in the future. Fat pad removal makes the hollow under the cheek more pronounced (think of the chipmunk cheek area) that is so often contoured with makeup. In your case it would enhance jawline definition. I would recommend you consider chin augmentation over buccal fat pad removal. Filler augmentation of the chin is gaining popularity also (because of cost and downtime). The results are more subtle but are definitely there. Computer simulation can help you make a decision. Hope this helps! Good luck

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  From the photos your cheeks are quite flat anteriorly (in the front), there is excess fat in front of the cheeks and in the lower face, jowls are present and the chin is weak.  These factors combine to create a long, rectangular shaped face. 
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 For well over 15 years now, my most popular facelift has been the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck 
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

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