Severely Sagging Skin at 24. Eyebrow Lift/face Lift Needed? (photo) (photo)

Question

I look so old and tired. My eye lids are droopy and I noticed that my forehead skin is loose now as well.I have bags under my eyes and on my cheeks (puffy), marionette lines and nasolabial folds.I stay out of the sun, don't smoke, use moisturizers, wear sunscreen, etc and it just keeps getting worse. I have tried an injectable filler for my nasolabial folds but it didn't help. My right side is worse than my left side, but it is quickly catching up.

Paul K. Holden, MD · Answer

Hi Selena,

	I see from your photos that you are unhappy with the distribution of volume (fat) in your face and how it is changing.  As others have said, this can be a sign of medical issues (like thyroid problems or metabolic disorders) or even stress.  The good news is that at your age, things can change for the better too.  You certainly do have elasticity in your tissues, which is what people lose with age.  Your main concern is the location and amount of fat you have.  If your BMI is on the low side, sometimes a little healthy weight gain will help.  If you have a more normal BMI, then follow up with your doctor.

	On the cosmetic note, Injectable fillers are probably going to fall short unless the volume you need is in the 1-2cc range.  On the other hand, you may benefit from a little more volume than that - which is probably more like 6-10cc per side.  This can be done with facial fat transfer which is minimally invasive and can be used around the eyes, in the nasolabial folds and the upper lateral cheeks in higher volumes.

	Before considering any of that, though, you should first get a complete medical work-up with your primary physician to ensure that you do not have some other process causing your issues.

	I wish you all the best!

J. Jason Wendel, MD, FACS · Answer

Thank you for your question and the photos. It is difficult to say the cause which could be medical, weight loss, or premature aging. Prior to having any significant plastic surgery done, see your primary care doctor to make sure that you do not have a medical condition causing this such as thyroid problems or a sleep disorder. Also, at age 24 minimally invasive procedures would likely serve you better than major surgery. I hope this helps. Good luck.

Christopher Kolstad, MD · Answer

Hello,

Thank you for including photographs with your questions.  It makes meaningful discussion about potential therapies a little more attainable.

You are still very young and have very healthy skin.  The lower 1/3 of your face looks age-appropriate around the jowls and you have retained youthful contours in your neck.  I agree with you that your midface has signs of aging.

Feeling like your appearance suggests an age greater than your actual date of birth is a common complaint.  For someone as young as you the first thing I would do is look at photographs of your parents when they were in their 20s.  Prematuring aging is largely dependent on sun exposure (which you are avoiding) and DNA.

The good news is that there are a number of available therapies to help improve the contours of your midface.  I would suggest a good place to start would be to restore volume in your cheeks and midface.  Nonsurgical fillers such as Sculptra, Radiess & Juvederm can be performed in the office.  A longer lasting solution would be fat grafting, which frequently requires a visit to the operating room.  I frequently recommend starting with facial fillers, but given your young age and loss of volume, fat grafting as an initial therapy is certainly a reasonable option.

Hope this helps.

Sam Naficy, MD, FACS · Answer

I agree that you should first get a check-up to make sure there are no general medical reasons for the loss of fat in your face.  Fat injections should help restore a more youthful appearance for you

Ronald Schuster, MD · Answer

I see what you don't like on your photos. You have premature loss of support in the mid-face area. Facelift surgery does not really help this area. Midface surgery might, but I think it would be "too much" for you at this time. First, if you haven't had a good check-up within the past year, I would start with a visit to your family doc, especially if you have any other "general" complaints, such as feeling excessively tired, cold, or weak. Get some bloodwork and make sure there is not a problem with your thyroid. Surgically I think cheek implants would help to address your concerns.

Miguel Delgado, MD · Answer

I understand your issue. Have you lost much weight? It does seem the skin is a little lax for your age. I would suggest a full medical work-up for starters. I would start with good skin care and retin-a to stimulate collegen. Injection in the nasolabial fold would be helpful and possible volume fill in the midface area.

Toby Mayer, MD · Answer

You have the most aging for a 24 year old I have seen over 35 years of plastic surgery. I would suggest you see an endocrinologist to determine a cause before you do any surgery to find out why you have this.

Kimberly Lee, MD · Answer

You photos show some volume loss in the undereye tear trough area. Although you would need an in-person consultation, you may benefit more from non-invasive treatments such as fillers as opposed to surgery.

Ralph R. Garramone, MD · Answer

I believe the primary issue is volume loss.  This would be more common at your age than looseness of the skin unless you lost a significant amount of weight.  I agree with the other physicians who recommend that you have a complete examination by your primary care doctor and rule out any medical issues which may account for the volume loss or weight loss.

	I do not believe that a surgical procedure is necessary.  I don't see enough laxity to make a facelift necessary.  I do believe you have had a loss of facial volume in the form of loss of facial fat which could be augmented with the use of injectable fillers like Restylane or Juvederm or a volumizer like Sculptra.  These products can be administered in a minimally invasive way with little or no downtime and they will offer a relatively long lasting result.

	Thank you for your question.

Jeffrey Epstein, MD, FACS · Answer

These are challenging cases, and it sounds like you may or may not in fact be an appropriate candidate for a surgical procedure, especially given how young you are.

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