Sagging chubby lower face: fillers, radiofrequency or lift? (Photos)

Question

I am a 32 year old female, 5.7 tall, 121 pounds, 25% body fat. I am experiencing sagging cheeks. I always had a rounded face. Although fillers are recommended, I feel in my case it will offer a very swollen and full face effect. I prefer something that lifts and sharpens the cheek line. Should I go for fillers, some sort of radiofrequency, Thread lifting or normal lower face lift?

Jason Emer, MD · Answer

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question.  It is very hard without a physical examination to see how much skin laxity is there.  A facelift is a lot of money and the change in you would be minimal. A facelift does only last about 10 years and year on year you start ageing the same.  So the likelihood is at 40 you would want another facelift. I would suggest trying thread lifts as this is a temporary to try and get you through a year or so until you have enough skin laxity to make a positive difference.  Please have a consultation with a board certified plastic surgeon.  All The Best

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

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts on women in their thirties who had early formation of "jowls" in the lower face.  From the photos your cheeks are very flat (actually concave) in the front and the chin is weak but there are no signs of jowls in the lower face.  There are signs of the cheek tissue collapsing and sagging which indicates a lack of underlying cheek bone support in the mid face = concave cheeks in the front.  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 precise placement of a dermal filler or using silastic 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 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.
 If you have "jowls” these are sagging facial tissues and the main 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.  This information is included for comparison purposes since you do not have jowls and as such would not be considered a suitable facelift candidate.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS 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.

Sagging chubby lower face: fillers, radiofrequency or lift? (Photos)

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