How to tighten or contour lower face? (photos)

Question

I am almost 26 years old and I feel like the lower half of my face is already starting to sag and I feel like my face always looks puffy. Is there a way to tighten or make my face look more contoured?

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Kimberly Butterwick, MD · Answer

You really seem too young to have sagging yet, but perhaps your weight has gone up and down with pregnancies or overweight issues. This can cause premature sagging. In addition, excessive sun in your childhood and teen years can already cause some laxity in the skin by the mid-20s.  You can firm up your skin by starting to get mild laser treatments now that stimulate the production of more collagen. Depending on what look you want, you have many options to lift your face subtly. Building up your cheekbones with Sculptra, for instance, or just adding it to your midface can create more volume, lifting and creating a more sculpted, defined look. You may also have some submental fat that can be dissolved with Kybella or other fat removal methods. 
We are lucky to have many, many options to help us improve and maintain our skin from youth to old age. Please find a board-certified dermatologist with whom you feel comfortable and confident to help you with this present problem, and prevent other problems in the future. It is good that you are looking to attend to the problem now before it becomes more noticeable.  In that way, you are rejuvenating and slowing down and preventing early aging. We call this “prejuvention.” Your dermatologist can also help you with a good skin care regimen of sunscreen and anti-aging products to keep you looking young for years to come.

Jason Emer, MD · Answer

A combination approach is needed to get the most improvement with skin tightening for the face. I recommend J Plasma, lasers (Fraxel, Clear + Brilliant, Co2), microneedling/prp, ultherapy and rf treatments to get the best outcomes. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Ryan Welter, MD · Answer

At 26, your skin still has great natural elasticity, so non-invasive and minimally invasive treatments can provide excellent results for contouring the lower face and addressing puffiness or early sagging. There are several approaches tailored to your age and goals.

For tightening and defining the lower face, Accent Prime is an excellent option. This non-invasive treatment combines radiofrequency and ultrasound to stimulate collagen production and tighten the skin. It is highly effective for areas like the jawline and cheeks, helping to create a more sculpted appearance with no downtime.

Another great option is PRP (Platelet-Rich Plasma) combined with microneedling. This treatment improves skin texture and firmness by stimulating natural collagen production, providing a subtle lift and reducing puffiness. When paired with proper skincare, it enhances the overall tone and contour of the face.

If puffiness is a primary concern, chemical peels or light resurfacing treatments can refine skin texture and reduce fluid retention for a slimmer, more defined look. A tailored peel can also help enhance skin tone and reduce early signs of aging.

For more localized contouring, Silhouette InstaLift, a thread-lifting procedure, offers a minimally invasive way to subtly lift the cheeks and jawline without surgery. This treatment stimulates collagen over time and provides an immediate lift, perfect for early signs of sagging.

To maintain results and slow aging, a consistent skincare regimen, including medical-grade products, hydration, and daily sunscreen, is essential. A consultation with a skilled provider can help create a personalized treatment plan that aligns with your concerns and delivers natural, beautiful results. At your age, a little care goes a long way!

Nuket Eroglu, MD · Answer

Hello, due to your age, the most sensible treatment I can recommend is Morpheus8. This treatment, utilizing bipolar gold-tipped fractional radiofrequency needles, is performed three times at three-week intervals. Morpheus8 has become a preferred skin rejuvenation procedure for achieving an aesthetic look and skin renewal in recent years. It is FDA-approved and particularly effective when used on areas like the neck and jaw, enhancing jawline contour and restructuring the facial region without the need for surgery. I recommend it with confidence.

Camille Cash, MD · Answer

You can consider treatments such as Morpheus8 to tighten tissues as well as improve overall skin tone and texture. We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Glenn Vallecillos, MD, FACS · Answer

The order of operations you should take to address your lower face sagging is above. But let me expand below:

*NOTE* You're very young and because of that you should only consider more invasive treatments and invasive treatments (Steps 3 & 4) once you're older and actually need them. At your age aesthetics is generally more about prevention than anything else.

1. Skin Care and Diet: 
Getting a complete and legitimate skin care regiment (making sure ingredients and effectiveness is at a quality level that you're comfortable with and desire) is very important for how your skin will age (gracefully like wine or stinky like cheese). Diet will literally make or break your mood, skin quality, results, and so much more. You truly are what you eat. I recommend noting how certain foods make you feel and staying away from anything that causes inflammation (or at least only consume those foods sparringly) such as fried food, processed foods, any sugar that's not from fruit, and if applicable, any foods that cause inflammatory responses for you personally.
If you get both skin-care and diet on point, you are already ahead of majority of people on earth in terms of self-care.

2. Non-Invasive: 
Radio Frequency Assisted Lasers (RFAL) & Micro needling will be able to give you better skin texture and tone while tightening your skin. In our office, we would use Morpheus8 to tighten your skin and Fraxel or Clear & Brilliant to address skin clarity and texture while treating un-seen sun damage. Micro-needling works wonders for building collagen and the overall texture of your skin; smoothing out your skin tone.

3. More invasive treatments
The next degree to consider would be something more invasive such as FaceTite, Threads, and Renuvion JPlasma, all of these methods will tighten your face from deep layers within your skin.

4. Invasive Treatments
It is not worth expanding on this because you're simply too young and do not require invasive treatment.  Something that you might want to put on your radar for the future is "buccal fat removal", as removing those fat pads will create a "slimmer" and "tighter" looking face that takes off the "rounding" of those who get the procedure done.

Shaun Patel, MD · Answer

Fillers can be used to enhance face shape and to improve face proportions. For example, you could have filler injected into the midface/cheeks to improve cheekbone definition. This could be combined with Botox/Dysport to the masseters (which would slim the lower face) to give the overall face a more contoured appearance. My go to device for nonsurgically tightening the skin is Thermage FLX. I have had the procedure done myself and recommend it highly.

Dean P. Kane, MD, FACS · Answer

Dear kcrowder, 
Thanks for sharing your photo. 
The beginnings of facial skin laxity start when skin repair diminishes and passive skin aging relaxes downward. 
 
 The web of fibrous compartments under the skin loses fat, stretches and elongates developing 5 growing “waves” of skin at points of attachment such as the:
  
hooding along the eyes,
  lower eyelid / cheek junction or tear trough / nasojugal fold
  nasolabial fold,
  lateral mouth commissure and marionette folds,
  jowls and neck.
  The skin itself is not dissimilar to crepe paper held together by collagen, elastin and other structural molecules which also passively diminish with aging.
  
Facial Aging are created from the 5 different layers of the skin, fat, muscle and bone. During the first 20 years or so of life, the body genetically determines how to develop and repair a constantly changing “face” including all these layers (as it does elsewhere in the body). Thereafter it remains robust in repairing itself from injury but the accumulation of environmental, health and nutritional exposure will add to the passive inability for the body to care for itself after 30. This is when physical changes such as skin laxity, irregular pigmentation, lines and wrinkles and skin diseases occur. We now have many options to rejuvenate the layer or layers of the face which need care or stimulation to reverse the aging trend.
So, it is important to understand there are 2 layers of the face and neck to rejuvenate; the laxed visible skin AND the sagging soft tissues under the skin. 
Today's options offer non-invasive, minimally invasive and surgical options. In general:The lower face can be reduced, lifted, tightened, and / orThe mid-face can be filled. Since I do not have the advantage to examine you, I hope you will be helped by the information below. My immediate recommendations are to obtain:
consultation with a talented, Board Certified Plastic Surgeon with extensive skills in:non-surgical skin tightening using Obagi ZO Skin Health Rx regimen and chemical peelsCoolSculpting to the lower cheek, jowl and jawline regionminimally invasive micro-lipocontouring of the lower cheek and jowlminimally invasive injectables including fillers and / or fat to the mid-middle-lateral upper cheekMinimally invasive Silhouette Suture Suspension of soft tissues and skinSurgical implants to the cheeksEveryone needs one or more layered improvement and in personalized combinations to achieve their optimal result. You can understand why it takes a talented individual, preferably a Board Certified Plastic Surgeon with great experience to evaluate your needs and find a plan that works best for you. All surgical, minimally invasive and non-invasive procedures and their combinations should be discussed following a proper examination with a well versed, Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.
 I trust this is helpful. All the best!

Bruce E. Katz, MD · Answer

Thank you for your photos. Based on your photos I think you would benefit from some dermal fillers like Restylane or Juvederm. Juvederm is an injectable filler that is derived from hyaluronic acid, like Restylane. Hyaluronic acid is a moisturizer found naturally in your body. Juvederm is created in a smooth gel, designed to make injections easier and results smoother. Restylane is created with very small granules of hyaluronic acid, which has a gel-like consistency. Another option to consider is Nova Threads which are dissolvable polydioxanone (PDO) threads made from the same dissolving material as surgical sutures. We use Nova Threads to treat lower face skin laxity and facial wrinkles such as marionette lines, nasolabial folds and laugh lines. For more information please make sure you a get a in person consultation from a board-certified dermatologist.

How to tighten or contour lower face? (photos)

Answers (12)

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