What can I do for my mid/lower face? (photos)

33 y/o female. I hate my nasolabial creases and my jowls look like they are sagging and my mid/lower face looks terrible overall. I have had fillers done on the folds which have almost worn off now, also cheek implants to help lift the cheek. What can I do to improve this area overall. I'm most self conscious of my nasolabial folds and jowls because I feel like I look like a Bulldog. Looking for a more permanent solution. Suggestions?

Doctor Answers 7

Need combo treatment

Your nasolabial folds are due to a loss of volume (therefore fillers) and some sagging.
A facelift helps pull and restore the tissues.
Both can help.
See a plastic surgeon for an evaluation.

Options for mid/lower face

Thank you for your question and pics.
Aside from your jowls, your lower face and neck seem to be in pretty good shape.  A limited scar facelift to address the jowls might be appropriate here.  As far as the mid-face, cheek implants do not lift the cheek.  In fact, they may have exacerbated your nasolabial folds.  In this case, a mid-face lift through a lower blepharoplasty incision might do the trick for your nasolabial folds in addition to smoothing out your lower eyelid cheek junction and fixing your tear troughs.  Please consult with a plastic surgeon who has experience with these procedures and who is board certified by the American Board of Plastic Surgery.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

Sagging Face -- Fillers/fat/sculptra, Thermi, Thermage/Ultherapy/Venus Legacy, Viva Resurfacing

There are a lot of options including volume with fat, fillers, sculptra and skin tightening with ultherapy/thermage and laser resurfacing.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Great Results

Hi Tlee1234

Thanks for your question and I'm sorry you are not happy with your features.

A facelift would be a great option. What makes the Concept™ Facelift so revolutionary is that it has the same results as traditional facelift methods but can have you back to work within days rather than months. If you are looking for a procedure that will flatter and rejuvenate you, without too stark a difference post operatively, then a Concept™ Facelift is for you.

One thing to note though is because you have already had surgery to the cheek area, this means there will be scar tissue so the cost and risks would have to be assessed at a consult.

Make sure you research all your options and see a qualified plastic surgeon who has lots of experience in this type of surgery.

Surgical and non-surgical options

You have various surgical and non-surgical options to treat your nasolabial creases and jowls. A facelift can treat your jowls and improve your nasolabial folds but keep in mind that nasolabial folds cannot be completely pulled away without tugging on the corner of your mouths and giving you a "done" look. Facelifts are becoming more popular in younger patients but may not always be necessary. Non-surgical options include Radiofrequency or Ultrasound energy based therapies which tighten the dermis without leaving scars. Speak with your plastic surgeon regardless the multiple options available and what results you can expect. 

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 12 reviews

Options for mid and lower face

Dear Tlee1234,
Your photos with the lipstick are stunning, and I am not sure it this is after filler or just a better shot. You will always have visible nasolabial creases no matter what you do, but filler is a great way of softening them. A little filler in your cheeks, pre-jowl hollows and commissures is also nice for balance. I would not advise any permanent filler because your face is always going to continue to change with time.
You are very young for a facelift, but if based on your exam there is enough room for improvement it is not completely unreasonable. Younger patients typically have beautiful and longer lasting results. That being said you will likely always benefit from fillers, so don't write off their power and convenience. 
Best of luck,

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 23 reviews

What can I do for my mid/lower face?

 Hi, I have performed mnay facelifts over the past 30 years.  From the photo, you have excess fat below and in front of the cheeks with skin laxity that has created the nasolabial folds and jowls.  These combine to create an elongated oval shape face.  

 Following the beauty principles outlined in my book on face and body beauty, 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 using a dermal filler (I prefer Restylane Lyft) or with cheek implants for a permanent enhancement will create full, round cheeks anteriorly that will feminize the entire face.  Since you already have cheek implants, the excess fat can be reduced with liposuction to further shape the cheeks.


 If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation.  I have performed many Cheek Augmentations over the past 30 years and the notion that Cheek Implants or dermal fillers alone to the cheeks will lift tissues is an urban myth.  Filler to the cheeks or cheek implants will shape the cheeks but will not lift up the jowls.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured.  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane and subperiosteal facelifts) but with these added benefits:

•very small incisions
•minimal tissue dissection = less bruising and swelling = rapid recovery
•can be performed in 90 minutes or less, with or without anesthesia
•no incisions within the hair = no hair loss
•excess fat can be removed
•excess skin removed
•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

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.