Facial sagging
Facial sagging describes visible descent or looseness of facial soft tissues, often around the cheeks, jawline and mouth. It reflects several layers of ageing rather than skin alone. Normal facial asymmetry and inherited anatomy influence how and where it appears.
What you may notice
- Lower or flatter cheek position
- Deeper folds beside the nose or mouth
- Jowling or reduced jawline definition
- Loose skin around the lower face
- Greater shadowing in facial folds
Why it can happen
Skin loses collagen and elasticity with age and sun exposure. Facial fat compartments can shrink or descend, retaining ligaments change, and bone support remodels. Weight change, smoking and genetics may contribute. A single visible fold can therefore result from skin, volume, support or several mechanisms together.
What may help
Sun protection and avoiding smoking help limit additional skin ageing but cannot reposition descended tissue. Energy-based treatments may offer modest tightening in selected cases. Fillers or fat transfer can restore selected volume deficits, while a facelift repositions deeper tissues and removes excess skin. Adding volume where descent is dominant may not address the cause. Assessment should consider the entire face, medical history and realistic goals.
When to consult
Consult a qualified clinician if you want the contributing anatomy assessed. Sudden one-sided facial drooping, weakness, speech difficulty or numbness requires urgent medical care and should never be treated as ordinary ageing.
Evidence and sources
- DermNet. Facial lines and wrinkles [Internet]. Auckland: DermNet New Zealand Trust; 2004 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/facial-lines-and-wrinkles (new tab)
- DermNet. Ageing skin [Internet]. Auckland: DermNet New Zealand Trust; 2018 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/ageing-skin (new tab)
- American Society of Plastic Surgeons. Facelift surgery [Internet]. Arlington Heights (IL): American Society of Plastic Surgeons; [cited 2026 Nov 7]. Available from: https://www.plasticsurgery.org/cosmetic-procedures/facelift (new tab)
- DermNet. Dermal fillers and augmentation procedures [Internet]. Auckland: DermNet New Zealand Trust; 2002 [cited 2026 Nov 7]. Available from: https://dermnetnz.org/topics/dermal-fillers-and-augmentation-procedures (new tab)