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

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.

Doctor Answers 19

How to improve the appearance of prematurely sagging skin of the face.

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Dear Selena, your post appeared today on my RealSelf Weekly Digest, but I see that you posted this 2 years ago and there have been 17 Doctor Answers. While I applaud the doctors for looking for medical reasons why you have a prematurely aged face, I could not find a good reason listed.
The 2 usual reasons for premature facial sagging are significant weight loss and genetics. Many people are significantly overweight as teentagers and lost that excess when moving into their twenties. Losing more than 10 pounds (5 kgm) leads to loss of fat on the face, sufficient to contribute to premature sagging. The other common reason is answered by your relatives, If your mother or an aunt or sister have this type of facial aging, it indicates it is due to the families facial  structure.
In terms of treatment, 1 of the 17 answers provided the correct solution, which is based on the recognition that your cheekbone structure does not have a good strength. The facial skeleton is made of bone, to which the  facial muscles and the facial ligaments, which function to support the soft tissues, are attached.
I suspect you intuitively realized that the many answers suggesting fillers as a solution are not going to provide a lifetime solution to your underlying  problem. They provide an expensive, short term improvement, which presumably is not the answer you are looking for. It would have been better for you if they had simply answered that they did not know what to suggest to help you. Some other doctors suggested using fat injections, which is a good long term solution in certain situations. But if the tissues are already sagged, and the bone structure is deficient, the risk is that the added fat, while improving voume will add to sagging.
When it is clear that the bone structure is not sufficient, the correct solution is to correct the projection of the bone. This requires the use of bone like implants, which increase the projection of the bone surface and with that, also increase the projection of the attached muscles and ligaments. Conceptually, it is that simple. Surgically, there are 2 types of implants used,solid Porex implants or granules of coral derived hydroxyapatite, discounting the use of silicone implants. When implants are correctly placed over the mid cheek they provide a lift of the mildly sagged soft tissues and a lifetime improvement of the look of freshness and facial attractiveness, provided of course the surgery is performed to a high aesthetic standard, which is what you would expect from leading surgeons.

Melbourne Plastic Surgeon
4.9 out of 5 stars 39 reviews

Avoid Surgery

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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!

Paul K. Holden, MD
Phoenix Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

Sagging Skin at 24

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  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.

Christopher Kolstad, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 59 reviews

Lift or fat young woman

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there is nothing to lift  your skin is young. It would benefit from a skilled fat grafting procedure shaping your face correctly Great result not a big deal

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

Surgery best choice.

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I presume you don't have any general illness (which has been excluded by our family doctor during a thorough assessment) and your tissue changes definitely indicate the need for surgical correction, mid-lower face and neck lift. Possibly a tissue augmentation material or your own fat transfer to the face may be used at the same time.

Kris Conrad, MD
Toronto Facial Plastic Surgeon
4.0 out of 5 stars 11 reviews

Volume loss in the face

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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.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Facelift - Severely Sagging Skin at 24. Eyebrow Lift/face Lift Needed?

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Hi-the photos are helpful (as is often the case when people want opinions on potential plastic surgery).  I can understand why you're unhappy (not SO bad btw but I see what you're talking about) but I can't imagine that a facelift would be an appropriate procedure for you.  It is almost never done on people your age and, if it is done on younger people, it's normally when there has been a significant weight loss or some other similar explanation.

You should first be checked out completely by your internist, just to make sure there's nothing wrong from that standpoint.  Assuming that that's okay, you could consider injectable fillers to adjust the volume in your face.  There are many different types of fillers and most are considered temporary although they last for varying amounts of time (depending on the filler).  Injectable fat is considered permanent by some people.

Once you're cleared medically I would most likely advise you to take that route

I hope that this helps and good luck,

Dr. E

Fat injection is your best bet

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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

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Sagging face at age 24

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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.

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

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  At 24, it's very unlikely that a Face Lift would be required.  The photos show very flat cheeks that could be augmented with silastic cheek implants.  I would suggest starting there and make sure the plastic and cosmetic surgeon, you choose, understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face.

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.