What can be done about saggy mouth and jowls at 28? (Photos)

Question

I need help with figuring out how to improve my face. The whole bottom half of my face is so saggy and it looks like I’m always frowning. It looks like I have fat cheeks but also jowls. I’m only 28! And weigh about 110 lbs and my face has always been like this. I have a bit of an overbite with a receded chin and might need jaw surgery if that would help? Or do I need cheekbone implants? Please help!!

Jason Emer, MD · Answer

For a more defined jawline to strengthen your profile (and help prevent the dreaded jawline "jowl" sagging), we use injectable fillers like Revanesse Versa - a filler known to limit swelling and give subtle, soft enhancements - or Radiesse. Using a cannula to limit pain and swelling, we inject on the bone in strategic points to get more lift and shaping, resulting in a more contoured lower face and defined, structured jawline. I would suggest getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Both implants and fillers in the cheeks can create good results for patients.  Both can build up the cheeks or improve volume in the lower face.  You must balance the pros and cons of each procedure and do what you feel is the best decision for you.
Fillers:
Pros: No downtime Reversible Quick
Cons: Temporary More expensive in long run
Implants Pros: Permanent Great for patients with poor bone structure Less expensive overtime
Negative: Risks associated with surgery: Possible infection, Downtime
Cost will vary depending on procedure. I recommend getting a formal consultation to discuss your desired results.
I hope this helps!

Alan B. Brackup, MD, FACS · Answer

Thank you for your question and your photos. Through looking at your photos and your profile I think you would benefit from a chin implant. Your chin is relatively shallow compared to your mouth and your nose and a little chin projection would change the shape of your face. You could also consider mid face (cheek) filler, something like Voluma which would give you cheeks/cheekbones you may have never had. I would recommend following up with a physician for a consult in person to discuss your needs. Hope this helps!

Nelson Lee Novick, MD · Answer

First, let me applaud you for expressing how your problems make you feel when you look in the mirror, i.e. saggy, jowly, and frowning. Many, if not most, people who present to aesthetic physicians do so with pre-conceived notions about which areas they think they need treated, such as smile lines, or marionette lines or even the under eye region. But disappointment and frustration is what most of those people will likely experience, especially when they get treated in those areas by inexperienced, novice injectors offering "one syringe of Juvederm or Restylane"  to treat those areas. A much more sophisticated approach by an experienced injector is to find out what the person feels about him/herself--which you have given us upfront--and then tailors an appropriate treatment plan to address those concerns.  The general order for treating the face is to first build the foundation. The foundation of the face is the cheekbone and the mid-cheek regions. Once this is addressed, with volumizing fillers, such as Voluma XC (which I would use in my NY office) and Stylage XXL (my choice in my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available) not only is the overall shape of the face improved, but secondarily the sagging and jowl formation remedied. Following restoration of the foundation, then contour can be addressed. In keeping with this, the side (profile) view suggests that the chin can be enhanced and its projection increased with Restylane Lyft (NY) and Hyaluronica 2 (Israel).  Finally, we can turn to refinements, which in this case might be the lips, especially the upper lip whose vermilion border and possibly even the red portion of the lip might be enhanced with Belotero Balance (NY) or Princess Volume (Israel). Make sure that you consult with a board certified aesthetic physician with experience and expertise in nonsurgical facial rejuvenation with injectable fillers and volumizers and who can create a specific treatment plan for your needs and to fit your budget. Avoid flea market style outlets selling treatments of simple Restylane or ordinary Juvederm by the syringe. Make sure to ask to see before and after photos for each area that you require treatment. Best of luck to you.

Zoran Potparic, MD · Answer

It is very difficult to give you good advice based on photos only; in-person evaluation would help. It appears that creating more harmonious face in your case may require several procedures; chin, possibly cheek augmentation, nose reshaping surgery, jaw-line enlargement (fat grafts) vs. orthoghnatic jaw surgery  and jowls contouring with liposuction. Some of augmentation may be achieved using fillers, which is of course temporary, but would give you good idea what would a more permanent voluminization of your face produce. Good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you are a candidate for malar enhancement.  This can be
done in one of two ways.  Voluma is an injectable filler which can be
injected into the malar region as a temporary filler.  Malar implants can
be placed as a permanent way to gain volume in the cheek.  I always use
medpor implants with screw fixation.  Silicone malar implants tend to
have a high rate of malrotation over time.   A chin implant can be
performed at the same time for a nice result.  The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Manjula Jegasothy, MD · Answer

Jawline shaping with Dysport® to lift the skin and Radiesse® to augment the jaw bone. Chin implant possibilities I am sure can be answered by a board-certified plastic surgeon on this site.

Barry Ginsburg, MD · Answer

you appear to have a "weak" chin which means it does not project forward enough.. this is very easy to fix it bellafill on the chin bone.. that will improve your profile.. you could also add volume along your jaw line and add volume on your cheek bone with bellafill...this would greatly improve your appearance...
look at a photo of angelina Jollee as an example of great cheek bones and jaw line

William Portuese, MD · Answer

From the photographs presented, there appears to only be a recessive chin profile  present for which a chin implant can improve.  Chin implants are manufactured and a large assortment of both sizes and shapes which is best determined at  the time of the consultation and examination.  In our practice, most patients receive a size small or medium sized implant which accomplishes their goals.  The procedure can be performed under local anesthesia as an outpatient procedure.  For diagrams of the implants and many before and after examples, please see the link and the video below

Gerald Wittenberg, MSc, DMD (retired) · Answer

You have a long face development pattern which yields a narrow face, narrow lower jaw, and shallow midface, with no defined jaw angles. The high slope to the lower jaw and the narrowness gives a "V" shape frontally. You coukd augment the lower jawline and combine with a genioplasty for better support of your soft tissues and balance. Other issues would be reviewed by the surgeon

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