The best treatment option for lower face sagging? (Photo)

I am 42 and have recently been to visit a CS regarding my lower face sagging. He has recommended botox along with dermal fillers in my chin and naso-labial folds. I am concerned that doing so may result in stretching my skin resulting in the sagging becoming worse. I have already tried Ultherapy which didn't work and have researched Thermage but that has very mixed reviews. Is there any other alternatives? How long will fillers last in these areas?

Doctor Answers 5

Sagging face skin

Thanks for your question.  The first thing that stands out to me is your chin. It looks tense and angry and is probably contributing to some of your concerns.  A few injections of Botox into the chin will relax and refresh your lower face.  Some other options include trying some Voluma in your cheeks to help lift the jowl and nasolabial folds and improve that area.  Ultimately, the final stage is surgical in terms of a neck or face lift.  Based on your age and how you look, I don't think you are ready for a facelift.  I think some more work with Botox and fillers should be able to get you to where you want to be before taking the plunge with surgery.  Fillers will not make sagging worse, in fact, overtime they strengthen and improve the collage and elasticity of the skin.  Fillers and Botox will give you an immediate effect but they take several years to start reversing the signs of aging.  Hope this helps

"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Treatment for sagging skin

You asked what is the best treatment for sagging skin of the face and there is no doubt that the best treatment is a face lift.  from looking at your photos you are wasting your time and money with these other options. see a board certified plastic surgeon for a consultation

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

The best treatment option for lower face sagging?

Thank you for your question and for sharing your photographs. I find that most patients seeking nonsurgical facial rejuvenation should consider it a process and not an isolated procedure.  Making steady monthly gains in improvement allows for tailoring of expectations to specific patient desires and gradual/natural improvement.  Based on your pictures I would recommend pursuing dermal filler use - such as Voluma - into your cheek prominences and jawline.  This placement would restore soft tissue atrophy and sagging of your mid face that contributes to worsening smile lines and lower lid support as well as would improve upon the early jowling.  See a board certified plastic surgeon in consultation for the best results. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Botox and fillers for facial rejuvenation

If Ultherapy didn't give you the result you were looking for, I wouldn't try Thermage as both are noninvasive skin tightening procedures with similar treatment profiles. 

I do believe you have volume loss in your mid and lower face and targeted filler placement in these areas will help to revolumize and lift the face. For example, Voluma, Radiesse or Sculptra injected into the midface (anteromedial and lateral) will help address age related volume loss is these ares. You have a recessed chin and volume loss along the anterolateral chin and pre jowl sulcus which would be helped by filler placement, my preferred fillers in this region being Juvederm Ultra or Voluma. Finally, filler into your chin and along the jawline will also help give definition to the jawline. 

None of what I say, of course, replaces an in person consultation with a aesthetic physician. 

Skin stretching from fillers?

With facial aging, your skin thins and fat and bone volume decrease. These combination of changes contributes to the appearance of skin sagging as the underlying support has decreased. Theoretically, OVERINFLATION of the face with fillers can increase the chance of the skin being stretched beyond its limits and worsening sagging. Avoiding overinflation with fillers should not worsen your skin elasticity. Alternatives could include CO2 laser resurfacing, fat injection to your face, or gaining some weight to fill out the face. It may be prudent to try fillers first as they are temporary to see if you like the look. Juvederm Voluma is purported to last up to 2 years while other fillers stay for 9-12 months depending on the area injected. For some patients with a receding/small chin, a chin implant or a sliding genioplasty can add structure and support to the overlying skin.

Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.6 out of 5 stars 5 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.