Depending on your age and profile, sagging can be due to a multitude of reasons. These include the loss of bony and deep fat support that happens with aging; gain in weight and increasing size of the overlying fat that subsequently sags; loss of muscular and ligament tension which contribute to hanging of the overlying cheeks. Stretching of the skin can cause pores/scars to look larger than t as you mentioned.
As such, we usually have to administer treatments according to your underlying issue:
1. Bony/deep fat volume loss: fillers can be used to effectively revolumise and restructure the areas that support and give contour to the face - the mid cheek, temples, jawline, chin, etc. This restores a more youthful facial profile, improves harmony of the face and has a lifting effect on the overlying sagging fat.
2. High-intensity focused Ultrasound: Used to stimulate the loosened muscular and ligamental layers of the face, tightening the face and improving sagging secondary to loss of tension in those layers.
3. Resorbable thread-lifts: These are placed into the upper layers of fat to move them into more favoured positions, improving sagging and contour of the face. These sutures dissolve over a period of 1-2 years, leaving behind your body's collagen and scar tissue that continue to give a sustained, though not complete, lift.
4. Surgical removal or laser-assisted fat ablation: if you have excessive amounts of superficial fat that produces jowling, removal of fat might be an option for you. Weight loss also helps reduce fat volume here.
In terms of the enlarged pores, certain procedures can be done to help tighten them specifically. These pores lie very superficially, so devices targeted at the skin is preferred. These include lasers, chemical peels, radiofrequency devices, and even botox.
It might be best to be seen in person so a plan can be worked out; most patients require a fair mix of the above to get optimal results.
Cheers and Happy New Year,
Dr Shane Abucewicz Tan
The Aesthetic Studio Clinic and Surgery
