Doctor's Answers (4)
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
In order to answer this question , a consultation and evaluation of the actual cause of the saggy cheeks must be done first .
The common causes would be loss of skin elasticity and collagen , loss of facial volume due to facial fat pads deflation , migration of fat pads downwards or increase in fat and ligament laxity ( especially the mandibular retaining ligament ) . Of course these causes could also coexist to a certain extent.
Treatment options should then be directed to the underlying causes.
1. Loss of skin elasticity and collagen — use of energy and light based devices . These include the monopolar RF devices like Thermage , Exilis Elite , HIFU devices like Ulthera, Ultraformer III and to a lesser extent lasers for collagen remodeling like Laser Genesis or the newer Picosecond lasers . We can also used Threadlifts to reposition the sagging skin using either the Korean PDO threads or the Silhouette threads with cones.
2. Loss of facial volume due to deflation of facial fat pads—- replacement of the fat loss through use of dermal fillers or fat grafting . Fillers of appropriate viscoelastity to replace volume and create a Lift can be injected in a subcutaneous or deep plane to corrrct the saggy cheeks
3. Heaviness of the lower lateral cheeks due to fat volume increase or increase of buccal fat can be addressed by use of HIFU devices to reduce the subcutaneous fat or as in the case of buccal fat through surgical buccal fat removal.
4. Combination of the above plus laxity of the retaining ligaments like mandibular , buccal maxillary and to some extent the zygomatic ligaments . These ligaments laxity can be corrected using the True Lift technique through the use of filler gel ( Restylane Lyft ) with high lifting capacity .
Hope this helps .
Dr KK Chew
Depending on the cause of the saggy cheeks, the extent of facial volumetric deflation(if any), degree of soft tissue descent, bone structure, skin quality, gender and facial proportions of the person. the following are some of the common treatment options that can be done to improve saggy cheeks/sagginess of the face in general.
1. Energy devices like Thermage, HIFU and Ulthera can help to boost collagen stimulation, tighten and lift up saggy skin over cheeks.
2. Dermalift or intradermal microbotox injections can also help to tighten and lift saggy skin over the lower face
3. Pulsed radiofrequency microneedling with Sylfirm can help to improve skin texture and firm up the skin
4. Filler injections at the right places can help with replenishing volume deficits, and provide lifting by providing support to weakened retaining ligaments, hence improving overall face contour and sagging.
5. Threadlift will give immediate improvement to moderate saggy lower cheeks and over time stimulate collagen to improve the overall facial contour.
Often, a combination approach is used to achieve the best results. Do get an assessment by a certified and experienced doctor who will be able to discuss the treatment options available with you and come up with a customised treatment plan for you.
There are very few energy device that can tighten the SMAS layer (superficial muscular aponeurotic system). This is a layer of strong tissue that extends from under jawline to the temple region. It is deep - under your skin and fat pads. It is also an important layer that plastic surgeons manipulate/tighten during a surgical face lift.
Highly intense focus ultrasound (HIFU) helps to perform a controlled damage (by heat) to the SMAS layer because the ultrasound energy can produce high heats (up to 60 degrees celcius) and penetrate deep (4.5mm) into the skin.
HIFU will help to improve the appearance of saggy cheeks by tightening the SMAS layer and pulling the fat pads of the cheeks upwards. I will always recommend a session of HIFU (for anti-aging). For medium or larger size faces, you may require 600-800 shots (during the HIFU session) and this is repeated once every 12-18 months.
Now, skin (epidermin/dermis) laxity will also increase the appearance of pores. There are so many options to treat this problem. Exilis, picosure laser, Lasemd laser and rejuran are effective options. Choice of treatment depends on your lifestyle and preference!
Finally fillers and botox may be required to further enhance facial profile and contour. Actually best results from fillers is from intermittent treatment over the years. Doing too much at one go may not produce natural results. However 2-4 syringes every year (treating different areas) makes a lot of difference to slowing down/reversing facial aging!