Asymmetric facial bulge - what options do I have besides a facelift? (Photos)

Question

Hi. I am 54 postmenopausal. I have lax skin which is much worse on on the left side just above the jaw. I think from years of leaning on my hand. My face is now asymmetrical and it often looks like I have a golf ball in there. I am scared to get a facelift just yet. Do I haave any good options? Thank you.

Semih Yildiz, MD, FEPOBRAS · Answer

The photos show mild lower-face laxity and jowl or soft-tissue fullness that appears a little more prominent on one side, but photos are limited and cannot confirm whether this is only skin laxity versus deeper volume, salivary gland, dental, or bite-related asymmetry. If this is a new, firm, painful, or growing one-sided lump, it is worth being checked by your GP, dentist, or an ENT/oral surgeon before treating it as purely cosmetic.

Without a facelift, the realistic options are usually conservative: skin-quality treatment or RF microneedling/energy-based tightening for a small degree of laxity, carefully placed filler or fat grafting to support the cheek, chin, or jawline and camouflage the transition, and neuromodulator treatment if muscle pull contributes. These can soften the appearance, but they will not remove a true jowl or loose skin the way a lower facelift/neck lift can. I would be cautious with thread lifts or aggressive fat removal, because they can be short-lived or make asymmetry and hollowing worse. A consultation with a facial plastic surgeon can help decide whether you are still in the camouflage stage or whether lifting would be the more predictable option.

Samuel Mattine, MBChB, MRCS, FRCS · Answer

Thank you for sharing the photos. You have some of the typical hallmarks of facial ageing and age-related gravitational forces, such as loss of tone and support, soft tissue ptosis, volume loss with jowls and marionette lines, and as such, in reality, nothing apart from a facelift would address these features. The facial asymmetry you have described is a part of the same changes; however, it is due to more severe age-related changes on that side. Ideally, a facelift (preferably Deep Plane ) is likely to give you the best outcome. Considering your reservation to undergo this surgery, a simple unilateral buccal fat reduction may be a good start to partially address your concern.

Gary M. Horndeski, MD · Answer

A facelift may be your best option. However, an alternative to consider, if you are scared of a facelift, is a lip lift. A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Asymmetric facial bulge - what options do I have besides a facelift? (Photos)

Answers (3)

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