Facelift for Younger People to Make Face Slimmer and Narrow?

Q: I’m 25. I know a facelift is usually reserved for older individuals with sagging or loose skin but I was wondering if it or something similar to it can be used on younger individuals to make the face seem more slim and narrow. I’m sorry I didn’t post any pictures but I have a squarish face. I wanted to get a lift around the cheek area to pull up skin to get a more narrow and triangular looking jaw. Cheek fillers aren’t possible because they widen my face.

A: Older people look squarer because of sagging, but used to look heart-shaped in youth.

Hi JC8222,

It’s unlikely that a facelift at age 25 will give you the results that you are seeking. When you are looking at before and after photos of facelift results, it is true that the squarish looking faces of older women appear more heart-shaped or triangular as you have pointed out. When these facelift patients were younger, their faces were already heart shaped, and with normal aging the sagging of the cheek fat and skin down the sides of the face protudes past the triangular point of the chin which causes jowling or sagging of the jawline. This makes them look square and more masculine.

For men, this squaring off of the jawline can actually make men look more masculine and sometime better with age, as long as they don’e have a significant amount of sagging neck skin under their chin, which offsets the improvement. This can make a baby-faced man (heart shaped face) look more square and they look more masculine with age.

From a front view, the jowling (sagging of fat/skin below the jawline) does make the face look squarer at the bottom contour of their chin and jawline, but on an oblique or 45 degree angled view, you will see that these patients have sagging fat protruding below their jawline, somewhere between the back edge of the jaw (angle of the jaw) and the chin, usually closer to the chin. This sagging jowl is what facelifts are designed for. Facelifts do not liposuction fat from the sides of the face, nor does tightening the skin compress the muscles, glands, fat, and other soft tissues of the face to make the face look thinner.

I’m guessing that you have tried simulating the look of a facelift on your 25 year old face and it appears that your lower face got slimmer when your pushed your cheeks upwards. Since facelifts are essentially a procedure to take the “slack out” of a sagging face with some excess skin, your 25 year old face which is already wide, will unlikely have any “slack” and instead has excess soft tissues which is going outwards from the sides of your face to make your lower jawline appear wider. If you don’t have much slack or sagging, the most likely result of a facelift is that you will look mostly the same, but with facelift incisions around the front of your ears.

Facelift at 25 is not the answer. A square face on a 25 year old is usually due to structural issues, pushing the lower jawline outwards and making the lower face look wider and thus square. Bone, muscle, glands and fat can make this area of the face wider.

The simplest problem would be if this were from having too much fat in this area paired with not being your ideal weight. If you feel you are 15-20 lbs over your ideal weight, then simply reaching your goal weight with the monitoring of a physician, dietician, or other professional, should narrow your face without needing any needles or surgery. If you are already at your ideal weight, or try this first and it doesn’t give you the results that you want then consider the cosmetic procedures which will cost you money.

Some people simply have a wide lower face right at the angle of their jaw. These people may have issues with grinding their teeth, require a tooth guard at night, enjoy chewing on hard things, and maybe even have some TMJ issues or jaw joint pain or clicking. If these patients have significant bulging of their jaw muscles at this location, the masseter muscles, then botoxing the lower edge of the muscle will reduce the volume right at this “corner” and make the face look rounder and more heart shaped. This will cause some fatigue with chewing initially and can take several weeks to see the results. The botox maintenance may be every 6-8 months, but may vary depending on the patients usage of the muscle, and their natural tendencies to use the muscle. If it can break their habit of over-using their muscle, which people often bite down or grind when they are stressed out, or they simply love chewing gum, nuts, ice, etc. If these habits are reduced when the patients muscles are weak, potentially the need for botox to maintain the results could be reduced.

Prominent bone at the corner of the jaw is the toughest to treat. This is major jaw surgery, which is performed from the inside of the mouth, and a reciprocating saw is used to reduce the corner of the jaw. This surgery is common in Asian, in particular Korea. The surgeon’s out there have the most experience with this type of surgery as compared to most American surgeons. This surgery has more potential risks and complications. Also, the results can sometimes look unnatural, since the corner of the jaw looks “chopped off” or too straight which looks weird in a different way from the square jaw. If the patient is willing to take the risk and likes the aesthetic of the results, then these are the patients who will go for the surgery.

Lastly for discussion purposes, but really “firstly”, there are some medical conditions of the parotid gland which can make the sides of the face look puffy like a chipmunk. This should really be ruled out first. If there is inflammation of the parotid glands, which are saliva glands on the sides of the face, this can cause the saliva gland to swell up. The parotid gland overlies the masseter muscle, so it can also add bulk to the size of the face similarly to the muscle hypertrophy. If the patient has one sided swelling, which is intermittent, these people may have a stone in their saliva duct similar to a kidney stone. When the stone blocks the opening the saliva backs up and makes the gland swell up like you are blowing up a balloon. When the blockage is opened the swelling will go down. If the person has swelling on both parotid glands, then it is unlikely that they have simultaneous stones blocking their glands, so the more likely scenario is some kind of inflammatory process which is affecting both parotid glands. A common diagnosis is Sjogen’s Syndrome which is when our own immune system attacks our glands. This can cause swelling of the Parotid glands, but the more common complaint is dry mouth along with increased cavities and other issues from not having enough saliva in our mouths. Sjogren’s syndrome can also affect our eyes, and in men, their fertility. Essentially it is attacking glands which help us secrete fluid, saliva, tears, etc. This inflammation can make these glands look bigger from the immune system’s attack. The most common age for Sjogren’s syndrome is in older women, but can occur at younger ages.

Before jumping into any cosmetic procedures, since we are still physicians before plastic surgeons, if a patient has a skin cancer, or other medical condition (autoimmune disease, bleeding issues, anesthesia issues, etc.) that we find during our initial consultation, those should be identified and treated before continuing on their cosmetic journey. Sometimes if the medical issue is identified, it may affect whether or not to perform the cosmetic procedure, or even effect the outcome of the surgery.


Dr. Yang