Sagging face at 23, what can I do? Am I a candidate for midface lift? (Photo)

Question

Hi, I am 23 and have deep nasolabial folds. I didn't have any when I was 18, and it seems like over the past 5 years, my cheek muscle/fat pad has descended and pooled around my nasolabial region. I have a malocclusion (slight overbite and slight lip incompetence), but when I spoke to a jaw surgeon, he said jaw surgery wouldn't help my nasolabial folds. I am really distressed by my nasolabial folds and hate being in lightings where they are obvious. Am I a candidate for midface lift?

Oliver Chang, MD · Answer

(Based off your single photo) - would be good to see the full face with eyes and brows to give a full evaluation - but seeing you have NLF - you can benefit from a midface lift versus fillers / fat grafting - results will vary based off the extent of surgical invasiveness you want to proceed with. A hidden scar midface lift can be done to also incorporate some eye rejuvenation (or perhaps changing downward slanting eyes to more upward). Just all depends on what your goals are and the downtime / risks you want to incur.

Ali Cetinkaya, MD · Answer

At 23, noticing deep nasolabial folds can feel distressing &mdash; especially when they weren’t there just a few years ago. From what you described, it seems like your malar fat pad may have slightly descended, which can accentuate the fold area. Coupled with mild malocclusion and lip incompetence, the midface may lack support, further contributing to the folds.
Here’s the key:Nasolabial folds are not exclusively age-related.They can become prominent at a young age depending on facial structure, bone support, dental alignment, skin elasticity, and even habitual facial expressions.
Now, is a midface lift an option at 23?There isn’t a universal yes or no. Why?
23 is young for surgical intervention in most cases.
But facial anatomy isn’t always about age &mdash; some individuals may benefit from earlier structural correction if there's noticeable volume descent or poor soft tissue support.
A midface lift does reposition the cheek tissues upward, which may soften the nasolabial area, but it's not a treatment for the line itself. It's about restoring balance to the midface.
That said, less invasive techniques (like deep structural fillers, thread lifts, or energy-based skin tightening) may be a more appropriate first step.
Also:✔️ Your sensitivity to how your face looks in lighting is very valid. It often means the issue isn’t just physical, but also psychological and emotional &mdash; and that matters.✔️ Whether or not surgery is the path for you, a comprehensive in-person facial assessment with a skilled aesthetic surgeon could help guide you through the safest and most natural-looking options.

Ajaya Kashyap, MD · Answer

Thank you for your query. I would not recommend a mid face lift at this time. Hyaluronic acid fillers can, however , help you with your naso-labial folds and other concerns. Please find an experienced board certified Plastic surgeon or Dermatologist who can examine you and help you with all your concerns. All the best!

Jacob Tower, MD · Answer

Hello, hope you are well. With such a limited view of your face, it's going to be difficult to receive any meaningful advice on the best course of action. I would be curious to see the profile view of your face with attention to the cheek volume and projection. There are a number of ways to reduce the appearance of nasolabial creases, but I would want to take into account your 3-dimensional appearance. You should have an in-person consultation for best advice.

Cheers,
Dr. Tower

Cheers,
Dr. Tower

Zoran Potparic, MD · Answer

It is very likely that small amount of filler injected into nasolabial folds would solve your problem. Face lift surgery is not a treatment for NLF in particular if so mild like yours. Good luck.

Michael S. Kluska, DO · Answer

Every one aging at different times. That said, you have some premature aging that could be improved with a both surgical and non surgical options including fat grafting alone or combined with a mini deep plane facelift. Nonsurgical options include the use of appropriate fillers to help add volume in key locations to rebalance your facial features.

Richard Wellington Swift, MD · Answer

Hello, Facial volume loss can be due to aging, weight loss and familial genetics. I would recommend the volumizer Sculptra which works by stimulating your body to make its own collagen and lasts 2 years. When injected properly it looks totally natural and you will look much younger. You do NOT need a midfacelift at 23. Also, Restylane, hyaluronic acid filler for your lower eyelids will also help. A softer hyaluronic acid filler directly along the nasolabial folds will soften the transition between your cheeks and upper lip. I have done this many times with great natural results. For additional facial balance have chin augmentation with a chin implant to add some volume and projection to the lower 1/3 part of your face.

Pawel Szychta, MD, PhD, DSc · Answer

At 23, a midface lift is uncommon. Deep nasolabial folds may result from fat pad descent, volume loss, or facial anatomy. Non-surgical options like fillers, skin-tightening treatments, or facial exercises can help. Consult a specialist to explore these before considering surgical options like a midface lift.

Mustafa Aydinol, MD · Answer

Yes you can get an endoscopic mid-face lift procedure to correct nasolabial folds and also a fat grafting to make the transition smoother. It is not possible to completely eliminate the folds as it is an anatomic landmark but you can see a significant improvement with the procedure. If you want to avoid surgery please try biostimulating fillers first to increase collagen formation.

David Guarin, MD · Answer

I do not recommend a facelift at this time. Non surgical tightening for the skin, such as radio-frequency, can be very helpful with an easy recovery. Fat grafing can be also considered.
David Guarin MD

Sagging face at 23, what can I do? Am I a candidate for midface lift? (Photo)

Answers (11)

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