Best treatment options to for smile lines, tighten sagging skin around mouth, under chin & lift skin under eyes at 29? (Photos)

Seeking professional opinions on best treatment options (surgical and non). What I've done to date: -Botox (since age 23) -Juvederm (lips 4/16 and a failed attempt to fix smile lines 7/16) -Voluma (1 vial each cheekbone 7/16, decision I regret bc undereye now looks more hollow) -retina-A since 2015 Factors: -intermittent smoking for a few a years -tanning beds as a late teen but religious with avoiding sun/using SPF since age 23 -gained 30 lbs In 2014 then lost 20 this year (volume loss)

Doctor Answers 13

Less is more

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Based on your photos, I would recommend procedures that are designed more for maintenance as you don't need much correction yet.  Procedures such as a mild laser resurfacing, good skin care, botox and dermal fillers would be helpful for you.  Talk to a board certified facial plastic surgeon to get a personal consultation.

Portland Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Best treatment options

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After reviewing your photos, at age 29, I feel that to soften lines, tighten skin texture and smooth skin surface, laser skin resurfacing combined with line/crease filler using Juvederm would be a good solution for your concerns.

Fred Suess, MD (retired)
San Francisco Plastic Surgeon

Options abound

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on what you can pursue but you should make sure whatever you do, that it will help you achieve your goals.  For loss of volume, you can continue the fillers or pursue fat grafting on the assumption you have fat elsewhere that can be harvested easily.  Nanofat would be used around the eyes to minimize the risks for lumpiness.  Rather than fillers for the lip, you could have lip implants that are 'permanent' and the costs fixed.  And finally, microneedling can be done to help with improving your complexion.  But I would believe that you would be still very attractive without any of the things you have done so far... so consider just going without and starting all over again if you truly feel you need help.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Improve appearance at 29

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Thank you for asking about your facial appearance.
  • First of all, you are very beautiful and it is important to keep that in mind.
  • What I notice first is your skin - 
  • Consider microneedling (Skinpen). It thickens the skin, adding some volume. 
  • For more volume around the mouth, with Juvederm unsatisfactory, small soft silicone implants may be the answer and perhaps a small chin implant for support.
  • However, a real risk for someone young, beautiful and a perfectionist is doing too much - start by doing the least and safest - a little more filler and microneedling are safe.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Best treatment options?

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Thank you for your questions.  You have recieved some good ideas from several doctors. Based on the photos the only thing I can add is to consider small volume micro fat transfer to the lower lid/cheek junction in order soften and volumize this transition area and thus avoid hyaluronic acid products (which can sometimes cause prolonged edema and/or a translucent appearance).

Aging changes around the eyes and mouth

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Hello AngelFace,Thank you for presenting your history of procedures, questions, and pictures.  I'm assuming the pictures are all taken around the same time period, and after your treatments were performed.  I see some of the aging changes you mentioned.  Because of some of the changes occurring and the filler you have had injected, I would recommend attempting to tighten the skin and different layers of tissue with some of the less invasive and noninvasive options.  I believe that will help with reducing some of the puffiness around the mouth region and cheeks.  The hyaluronic acid fillers you have in your face draw water into the tissues and can cause some puffiness.  Whether you have Thermage, Ultherapy, or any of the needle RF treatments, I do think this is the first step for you.  Whether you would need additional filler in the future is possible, or even fat transfer, would be a nice option, start with those treatments I recommended.  If you would like to come see our office, we have complimentary consultations.  Best of luck to you!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Skin tone and fullness

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Hi!  You have such a beautiful face!  I can see where you are wishing for better contour in certain spots though.  For the small lines around your mouth I would recommend filler as well.  As for your chin - I don't see any sagging skin!  You have a very youthful cervicomental angle and I don't think I would advise changing anything there.  I think you would get the most improvement out of some skin resurfacing under your eyes.  It's not so much a contour issue as a thin skin / transparency issue.  In the photo you like that is well lit, I suspect you have some lightener or concealer under your eyes.  Either an erbium or CO2 laser resurfacing will thicken up your under eye skin and make it less translucent (showing dark circles or puffiness) as well as less prone to those fine tissue paper wrinkles we get there as we age.  Those lasers will make your skin red and sore for generally a week to ten days, and afterward it will initially look exactly the same.  The real improvement will come in the next six months,as the energy from the laser causes the skin to thicken and lay down new collagen.Best of luck!

M. Renee Jespersen, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 7 reviews

Fillers may help

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Thanks for the great question and the photos. In my opinion, you look like you'd be a good candidate for hyaluronic acid (HA) fillers. As people age they tend to lose facial volume around their eyes and in their cheeks. Having a some filler placed beneath your eyes would fill in those hollow areas. Filler may also be placed around the mouth to give it more volume. Make sure you see someone with a lot of experience injecting around the eyes as this can be a tricky area to get right. Best of luck!~Dr. Sieber

David A. Sieber, MD
San Francisco General Surgeon
5.0 out of 5 stars 40 reviews

Treatment options

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I think you have had enough Bototx and fillers.  My only suggestion from your photo would be some filler in your Marionette lines (Radiesse or Juvaderm), and perhaps a small uper lid bleharoplasty, removing only a little bit of skin to remove the redundance.  Decisions are best made by a peresonal consultaton with your plastic surgeon and his/her injectionist.  Keep up the excellent care of your skin

Paul Silverstein, MD (retired)
Oklahoma City Plastic Surgeon

Volume loss

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You're doing almost everything correctly. It's just those pesky under eye areas that always thin out and show up starting around age 30 as the cheek drops, especially with weight fluctuations. Luckily you have very minimal issues, so they can all be fixed with a little filler. Either sculptra or Voluma for the under eye area, though it has to be done carefully/expertly, which can also give you a little bit of a liquid facelift effect.  Ultherapy, a tiny amount, could help also pull in the cheek skin so the folds aren't as deep, but I'd do that last after the filler. You need to go slow, step by step, gradually, and not rush it. You look young so these are all small changes

Cain R. Linville, MD
Houston Plastic Surgeon
5.0 out of 5 stars 39 reviews

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