I'm 27 and my face is sagging significantly and my skin texture is disgusting. Will fillers and Botox help me? (Photo)

Hi, Please could someone help me. I would like to know what it is I need to do to improve my face. its not symmetrical as ive pointed out in the pics and also getting some bunching when I pull certain faces on top of that its loosing elasticity and getting fine lines on my cheek when I smile, . The smile is so un even I never want to smile which is ruining my quality of life.Thanks in advance for your advice

Doctor Answers 12

Aging skin, wrinkles, blemishes, jowling and folds; what's a pretty girl to do?

Dear fillerandbotox11:

Thanks for sharing your photos!  While I believe you are being too harsh on yourself, there are many things available today for "rejuvenation and anti-aging" there weren't even a decade ago. 

Botox and Fillers will not help you with skin texture, elasticity and pigmentation.  There are many ways to reduce lines around the mouth and lips, fill the aging descent of skin and soft tissues and rebalance facial expression. Each depends on the level of the wrinkle deformity, ie., epidermis, dermis, fat, muscle and skin color.

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin" Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin. Voluma and Lyft are the longest lasting HA fillers, up to 2 years and 1.5 years duration HA. Each one is used to expand, project or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Restylane Silk is a wonderful new addition to the filler family. It is thinner and smoothening, particularly for the lines around the mouth and lips. I have also found it useful for the crow's feet and forehead lines too.

Scuptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles even around the mouth!
1. Fillers in the lip like fillers elsewhere require and understanding of the anatomy and injectable results. For example:
  • beyond the white roll, upper and lower lip wrinkles improve with Botox and smoothening fillers such as Silk in the dermis
  • the white line and philtrum project better with smoothening or volumizing fillers like Silk or Restylane
  • the lipstick lines of the dry (pink) vermillion are best injected with a volumizing filler like Restylane in the sub-mucosal layer
  • lip fullness is best with projecting to volumizing fillers such as Lyft, Juvederm Ultra Plus along the wet/dry border of the vermillion lip
  • lip pout can be improved with filler injections in the buccal mucosa (ie., back of the lip, inside the mouth) allowing the lip to push off the teeth.
2. Artistic use of Botox and similar injectable muscle relaxers just outside the upper and lower lip white line will reduce lip creasing and increase the pout of the lip(s) without fillers.

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

These options maybe used similarly around the eyes with the caveat that the Injector must understand the art and science behind the injectables he or she are using and the anatomy and dynamics of facial expression.

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 hope this has been helpful. All the best!

Baltimore Plastic Surgeon
4.8 out of 5 stars 82 reviews

Facial Rejuvenation


Thank you for your question.

It is very common to have facial asymmetry and a difference in muscle movement on each side of the face. If this is something that bothers you, it may be helpful to discuss subtle options for injectable treatment, (Botox or Dysport for example.) with a skilled injector, and then decide if that's the right option for you.

Injectable fillers and dermal fillers are products that erase the signs of aging in a simple injection treatment. These may help restore lost volume and fill line. 

Concerns with texture are typically best addressed with laser treatments and/or skin care products. 

I'd recommend booking a consultation with a skilled and qualified injector to determine your best treatment options. 

All the best.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Options for facial rejuvenation in a young person

Thank you for your questions. You do appear to be highly critical of yourself and I would caution against striving for perfection as there is always something we can find that isn't quite the way we might like it. Improvement is a healthy goal. With respect to which treatments or procedures may be best for you, I would strongly recommend evaluation by a highly experienced physician who can make some recommendations that might address your needs

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

Non-surgical facelift

I think you are being extremely mean to yourself, but yes, there are lots of non-surgical facelift options that may help you to improve your self esteem. Botox and fillers can aid with wrinkles and asymmetry but skin texture is best addressed with skin care products and/or lasers. Best, Dr. Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Will fillers and Botox help me?

Botox or Juvederm shots will help you improve your appearance. Some skin care will help as well, white skin tends to age fast. Good luck! 

Yily De Los Santos, MD
Dominican Republic Plastic Surgeon
4.3 out of 5 stars 1,708 reviews

I'm 27 and my face is sagging significantly and my skin texture is disgusting. Will fillers and Botox help me?

Hi, non smiling photos of your face from the front and side would be the most helpful in the evaluation.  These photos do show that the cheeks are flat anteriorly (in the front) which tends to elongate and masculinize a female face.  There is evidence of skin laxity and texture issues as well.  Botox relaxes the muscles that create unwanted lines and wrinkles and as such would not create a more youtful, feminize face overall.

Cheek augmentation using a dermal filler (Restylane Lyft) can create full, round cheeks in the front that will feminize the entire face.  Cheek implants can be used for a permanent enhancement.  A 30 % TCA chemical peel can improve the texture and tone of the facial skin.  If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured. The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

•very small incisions
•minimal tissue dissection = less bruising and swelling = rapid recovery
•can be performed in 90 minutes or less, with or without general anesthesia
•no incisions within the hair = no hair loss
•excess fat can be removed
•excess skin removed
•cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Perlane) or facial implants
•most patients fly back home to parts all over the world in as little as 3 days post-op

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Unhappy with face at 27

Thank you for asking about your facial improvement.

  • I am sorry you feel so poorly about yourself. A lot can be done to improve your self-confidence.
  • But - I don't see abnormal asymmetry in your face.
  • Everyone is significantly asymmetric - nothing in our body totally matches the other side.
  • I suggest you start with skin care - you have a delicate skin with what appears to be adult acne under make-up.
  • The bunching from pulling certain faces is normal muscle action -
  • A tiny amount of Botox can soften that.
  • Botox and skin care will hep the fine lines and the skin's elasticity.
  • If you spend a lot of time on the beach and in the sun - please reconsider.
  • The English skin does not take kindly to excess sun.
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

??? Face sagging


I do not think you do need neither Botox nor fillers !!

best wishes

Mr J Tahery 
Otolaryngologist /Facial Plastic Surgeon

Jawed Tahery, FRCS
Manchester Otolaryngologist
4.4 out of 5 stars 86 reviews

Fillers and Botox for sagging

You would benefit with the injection of Botox and some filling materials and could get treatments for skin tightening and a regimen to smooth your skin.  You should see a board certififed dermatologist experienced in cosmetic work

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 4 reviews

Skin Texture and Sagging

A combination of fillers, skin tightening (Thermage) to produce collagen and improve the jowls, and Clear&Brilliant to improve the skin texture would all help.  Please consult a board certified dermatologist who specializes is cosmetic dermatology for the best results.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 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.