What can I do about this saggy face? My nose? (Photo)

Just turned 34 and within the last year, I've aged a lot (to me). Lots of sun damage and relapsing from an Eating Disorder which clearly took a toll on my face. Would I benefit from just a bit of Voluma in my cheeks? Could I get away w/ 1 syringe of Voluma? Fillers around mouth? Also, I have a deviated septum and a bone spur inside right nasal passage that needs to be shaved down. I feel one side spreads more in width, is that b/c nose is crooked? I feel my nose has spread around nostrils a tad?

Doctor Answers 9

The amount of facial filler needed is determined by discussing with your doctor what a satisfactory end result is for you

Thank you for your question. You’re 34-years-old and you feel like you’ve aged a lot in the past year, due to an eating disorder relapse and sun damage. You’d like to know if you can benefit from added volume in the cheek areas and whether 1 syringe of Voluma will do the trick.
I can certainly guide you in this type of situation. To give you a bit about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I specialize in skin rejuvenation and facial aging with both surgical and non-surgical interventions, and regularly use quite a number of injectable fillers in my practice, namely Voluma, Juvederm, Restylane, and the like.
The answer to the question of whether you can get away with 1 syringe of Voluma depends on what is a satisfactory outcome for you, and whether you will be satisfied with the effects of 1 syringe. To help you understand the concept of volume, when you say “1 syringe” that’s essentially 1ml of filler, which is quite small. If there are multiple areas on your face that you’d like to improve, it will probably take more than 1 syringe. Keep in mind also that injectables are not cheap, so you will be looking at a certain cost.
Communication is absolutely key.  When patients come to my practice and consult with me regarding these things, I feel like it is my job to be their primary care doctor for beauty because many of these people enter into this area of cosmetic medicine, cosmetic dermatology, cosmetic surgery with different levels of experience, knowledge, and personal comfort. Often, they want to be more conservative, which is fine, but ultimately, it is important to clearly define what a successful and satisfactory outcome is to you. In order to help my patients reach this conclusion, I will take photos, put them up on the screen, and then have the patient look at their face from different angles, so they can get a better sense of what is possible. This is very important because when you invest your time and resources towards anything, you want to make sure you do it adequately and that you walk away satisfied.
In my practice, when I do procedures such as structural volumizing, more than one syringe is needed to enhance the cheeks, the jawlines and the chin; and again, what we can’t really determine about your question is whether or not you will be satisfied with one syringe. I always try to work within the patient’s budget, and if they want a more conservative approach. Sometimes, when they come back for their 2-week or 1 month follow-up, they’ll say that they were hoping they could’ve have gotten more. So I try to explain that if we want to establish a desired outcome, there is an estimate of how many syringes and material are necessary. Improving the cheeks, nasolabial folds, lips, marionette lines, jawline, and jaw angles all come with a certain amount of volume needed, and this is what I spend a lot of time counselling patients on so they make better informed decisions.
However, in your case, because you are also dealing with the stressors of other issues that also deserve a lot of attention, I wonder whether or not this is the right time for you to do this. I do understand the mind and body connection and how looking at your appearance and liking what you see can put you in a more positive state of mind and make you feel empowered. An interesting anecdote: one of the oldest patients I ever performed face lifting surgery on was 87-years-old, and she had the strength, energy and vitality of a 60-year-old. She told me whenever she gets tired, she looks in the mirror and says “hey, you look only 60-years-old—you can handle whatever the problem is.” I think this is a lovely example of how a little can go a long way.
I think you could get away with 1 syringe of Voluma, but I suggest meeting with a doctor who you feel comfortable with and learn more about your options. I will caution you, however, that because of the kind of volume loss that you feel you have experienced with the eating disorder, you may need more than 1 syringe in order to see a significant enough difference to justify the time and expense.
I hope that was helpful and I wish you the best of luck!
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New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Your early aging concerns are common and you appear to be a good candidate for Voluma.

First, regarding your sagging face, I believe it is minimal and would suggest you start with only one or two syringes in you cheek and midface areas.

Secondly, regarding your nose, it sounds as if you have visited someone who diagnosed a septal deviation with bone spur.  I cannot see your nasal deviation in the pictures, but this may be correctable with rhimoplasty.  Both Voluma and Septo-Rhinoplasty can be performed at the same time.

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

What can I do for a saggy face?

Thank you for your question and providing photos. As you age your skin gets thinner and loses elasticity. It also is accompanied by a loss of collagen, hyaluronic acid and elastin. Fillers, such as Voluma, would be a beneficial option for adding volume back to your face. Most likely, you will need more than one syringe. However, if you want to start off with one, you can gradually add more until you achieve your desired results. Just wait two weeks in between injections. I recommend you see a Board Certified Plastic Surgeon to discuss treatment options.

Saggy faces respond well to adding volume and tightening skin.

Patients in their early 30s are noticing the skin is not as firm and lifted as it was.  This occurs due to loss of fat under the skin (regardless of  weight) and increasing skin laxity.  The combination can make you look older and tired.  Ultherapy is a wonderful noninvasive procedure that gives firming, tightening and lifting with a single treatment.  Results can last up to 2 years.  Volume replacement has never been easier with Voluma (a Juvederm filler) that really puts that apples back in your cheeks. Two to 4 syringes are typical depending on individual needs.  One might consider a single syringe and see if that does the trick but most will be happier with 2 syringes.  Start with one and see what you think, you can always add. Voluma also lasts up to 2 years.
Don't forget good skin care like SkinMedica to feed and stimulate your skin to produce collagen.  Collagen makes the skin plumper and more youthful.

Susan Van Dyke, MD
Paradise Valley Dermatologic Surgeon
4.5 out of 5 stars 35 reviews

Natural Results with Juvederm and Voluma

Thank you for your question and for sharing your photographs.  Based on your photographs, you appear to be an excellent candidate for both Juvederm and Voluma.  With both products, you can achieve a natural, refreshed look by correcting age-related volume loss in your cheeks and around your mouth and nose.  More than one syringe will likely be required for optimal correction.  Please be sure to see an experienced injector for an in-person consultation to fully discuss your goals and expectations in order to determine the best course of action.  Best wishes! 

Christian N. Ford, MD
Cohasset Physician
5.0 out of 5 stars 31 reviews

What can I do about this saggy face?

Thank you for your question and for sharing your photographs.  I think Voluma can be used to help start you on your bath of facial rejuvenation and improvement.  Well placed Voluma will help elevate and fill your cheeks, improving mild sagging and the appearance of your smiling line facial creases.  I do think that you will need more than one syringe but you can incrementally add to your results until they approach what you are looking for.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 68 reviews

Non-surgical options for aging face

I know it's hard to look in the mirror and see the changes that occur with time, but you do not look overly "aged" in your photos. A bit of non-surigal facial rejuvenation will perk you right up. Schedule a consultation with a board certified plastic surgeon in your area to be assessed in person and discuss your filler options. Voluma is ideal for plumping the cheeks. In terms of your nose, this might require surgery so make sure that whomever you see also performs rhinoplasty.


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 34 reviews


Thank you for your question Cj15. Voluma is a filler used to enhance the appearance of the face. Voluma is frequently used to enhance the cheeks and lift the lower face.P In my patients I find that starting with 2 syringes is conservative. When using only a single syringe patients often times do not see improvement and are unhappy. There are 5 syringes in a teaspoon so using one syringe is the equivalent of putting one tenth of a teaspoon in each cheek (no a lot). Fillers can be placed around the mouth as well. For my patients I recommend starting with Voluma in the cheeks and assessing the results two weeks later. At that time Juvederm can be placed around the mouth if necessary. Please consult with a doctor for specific recommendations.  Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 4 reviews

Sagging Face -- Fillers/sculptra, Thermi, Thermage/Ultherapy/Venus Legacy, Viva Resurfacing; Neck/Face Lift

There are many options but you likely need a combination of skin tightening and fillers to start.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

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