What can I do to improve my bottom heavy face shape? (photos)

Question

I really dislike my face shape and feel like it’s too bottom heavy. I have a large forehead and a long nose so I feel my face shape accentuates this. I have masseter Botox already, but I still wish my face was more heart shaped. I can pull quite a bit of the skin to make it appear slimmer but I’m not sure what my options are.

Hung William Song, MD · Answer

Hi there. Thanks for your question and for posting your pictures. It looks like you have some volume loss in your temples and upper cheeks. This volume can be replaced with fillers, but it usually takes a lot of syringes of filler to get a good result and the fillers have to be repeated every 6 months to 2 years depending on which filler you use. Bellafill® is a collagen stimulating filler with PMMA particles which are more permanent, so this could be an option. My favorite way to address this issue is with an autologous facial fat transfer procedure. We harvest your own fat from another area in your body and then use it to add fat back to areas where you have lost volume. If this is done correctly, you can get very natural looking results that can last for the rest of your life. You can also do a booster periodically to keep up with aging.

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Botox is generally recommended for reshaping the upper third of the face and the jawline, but since you didn’t find the results satisfactory, dermal filler injections may further optimize your Botox results. 
Dermal fillers can target certain areas of the face to provide a lifting effect and define the contours of the cheekbones and jawline. I recommend scheduling an in-person consultation with an experienced, board-certified injector who can assess your current Botox regime and help you decide on the best step forward.

Camille Cash, MD · Answer

You may want to explore Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Typically three treatment sessions are recommended for optimal results.  We also suggest using medical grade skin care products like Transform MD and wearing sunscreen every day.  I've included a video on Morpheus8 that I hope you find helpful.

Darryl J. Blinski, MD · Answer

After reviewing your posted photos I recommend anterior mini Face Lift with SMAS plication with jaw line HA fillers. Fee $8,000. Best to virtual consult with....

What can I do to improve my bottom heavy face shape? (photos)

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