What's the best treatment option for thin & happy 40 y/o with impossibly droopy full lower face? (Photo)

I've had 2 consultations. One facial plastic surgeon advised against buccal pad removal. The other said lipo on face, neck and jowls to help with symmetry, but sagging skin may warrant facelift. Skin very good otherwise. I'm single, age 40, 6 years after divorce I want to love the way I look. It's getting worse. Anything short of a joker grin looks like a grimace or leer. Radiesse was suggested but not impressed by before & afters. Any ideas and thoughts from doctors would be appreciated!

Doctor Answers 16

Best Options for Heavy Neck

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Before a patient could be candidate for a surgery, they have to be in great health. If a patient is in good health, then I look at the anatomy to guide my recommendations. When looking at your anatomy you have:

1) Excess skin in the neck
2) Poorly defined jawline
3) Excess fat in neck
4) Weak Chin

In my practice I would recommend:

1) Neck lift
2) Chin Implant

These 2 procedures will provide a long elegant and defined jawline.

I hope this helps.

Early facial aging in sagging lower face?

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Sagging skin is best treated with a facelift. Patients never want to hear this but this is the only way the skin that is sagging can be removed. I would recommend against buccal fat removal and minimal liposuction of your face. You will need the fat in your face to prevent further sagging as you age and will make you look much more youthful. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

What's the best treatment option for thin & happy 40 y/o with impossibly droopy full lower face?

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Facial rejuvenation varies from surgeon to surgeon and means different things to different patients. In general it is the process to try to reverse the facial appearance caused by aging. It may involve improving the skin texture and complexion, diminishing skin discoloration, minimizing fine lines and wrinkles, contouring hollows, or tightening loose tissue that has lost its elasticity.

There are a variety of procedures, both non-surgical and surgical which can be utilized to achieve these various goals. Fillers, Botox or Dysport, micro-fat grafts, chemical peels, a skin care program, lasers, skin tightening, and surgical lifts are some of the methods that are used to achieve a cosmetic improvement. Each has advantages and disadvantages as well as limitations of what they can achieve. The best technique or combination of procedures depends on patient concern, desired outcome, individual anatomy, underlying medical health, and extent of aging. There is no one approach that is ideal for everyone. While fillers and non-surgical procedures may have some benefit in the appropriate patient, they will not produce the same degree of long lasting improvement that is achieved with a facelift and micro-fat grafts of depressed areas in a patient with your anatomy.

It is important to realize that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on limited photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla,California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Lower Face Lift

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Save your money on the fillers.   Fillers will not solve your problem.  You have too much skin and surgery is your best option.  I would do a lower facelift with liposuction of the neck to give you a pleasing cosmetic result.  Seek a board certified plastic surgeon in your area.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Treating a Male's Lower Face Concern

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During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. 

If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives. It is extremely important to seek a board certified plastic surgeon highly trained with your desired procedures. I also encourage you to look at before and after photos of the surgeons actual patients. Also, reading patient reviews of those who have had combined surgeries will be beneficial. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Concept Facelift Under Local Anaesthetic

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Thank you for your question.

I have pioneered a revolutionary local anaesthetic facelift known as the ‘Concept™ Facelift and Necklift’. This innovative procedure combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days.

The Concept™ facelift is suitable for men and women who wish to reduce sagging in the lower face and neck and regain a more natural, rejuvenated appearance. The procedure is less invasive than a traditional facelift and there is less scarring, bruising and swelling for a significantly quicker recovery period.

What are the benefits of the Concept Facelift?

  • Minimally invasive as it is a short scar facelift
  • There is minimal bruising and swelling, especially when compared to traditional facelifts
  • As the procedure is performed under local anaesthetic, you can go straight home following the procedure
  • Full recovery in a matter of days rather than months
  • Significantly less risk than Facelifts performed under general anaesthetic
  • Fresh, youthful and long lasting results
Please book a one to one consultation to seek advise from a board of certified plastic surgeon which specialises in facial procedures

All the Best

Droopy sagging

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After reviewing the pictures, haven a lower face lift is probably the best procedure for your because it will redefine your jaw line, removed your loss skin in give a more permanent and natural look


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You would be best served with a facelift.  You have excess fullness of the jowl area and descent of your cheek pads as well.  This would all be corrected with a facelift, as well as improve your neck and jawline contour.  Fillers will only make your face fuller with less aesthetic improvement. 

Is 40 years of age too young to consider a #facelift? it depends...

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Thank you for your question and pictures.

The down-turned mouth corners can only be lifted with a facelift procedure.  I would recommend a 2-layer SMAS facelift.

Fillers will only help slightly and temporarily.  If you choose the facelift procedure, a small amount of fat grafting to the marionette area would help.

I would not recommend buccal fat pad removal as very quickly over time it will give you a gaunted look.

Liposuction to neck would be recommended but conservatively as to not skeletinize your neck.

Hope this helps!

Dr. Marc DuPere, Toronto plastic surgeon

Marc DuPéré, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 71 reviews

What's the best treatment option for thin & happy 40 y/o with impossibly droopy full lower face?

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  Hi, based on the photos your face is an elongated oval shape.  This is created by having flat cheeks anteriorly (in the front) combined with excess fat in the lower face (in front and below the cheeks) and a weak chin.  There is evidence of jowls along with excess fat and skin below the chin.

 I have performed many facelifts over the past 30 years and the presence of "jowls" is the primary indication for some type of a facelift.  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 Restrylane Lyft) or with cheek implants for a permanent enhancement will create full, round cheeks anteriorly that will feminize the entire face.  "Jowls" represent 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.  In order to lift and minimize jowling, 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

A weak chin creates an imbalance making the nose look larger and the mid face appear top heavy.  Chin
augmentation can be performed during the facelift using a dermal filler, or a chin implant for a permanent enhancemet.  Placing a silastic chin implant through a small, curved incision under the chin will add projection to the chin creating harmony and balance to the lower face.  

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 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.