I am a 35 year old male. I have become increasingly unhappy with the lower half of my face. If I look down at all, I have a double chin. My cheeks are flat. I have been thinking about chin lip or a neck lift and I have also been thinking about doing something to help my cheeks. Any suggestions or comments? Thanks for your time.
Chin Lipo Or Neck Lift And/OR Cheek Fat Transfer?
Doctor Answers (11)
Facial Rejuvenation, Neck Lift, Midface Lift, Cheek Lift
From your main complaint and pictures "I have become increasingly unhappy with the lower half of my face. If I look down at all, I have a double chin. My cheeks are flat", the best treatment would entail a neck lift with liposuction and fat injections to the face, including the cheeks. You might consider undergoing a mid-face lift at the same time. he best treatment can only be determined by a thorough examination. From El Paso, Las Cruces, Mexico.
The Nonsurgical 3D Vectoring FaceLift & Necklift Are Excellent Techniques For Rejuvenating the Mid to Lower Face and Neck
Fortunately, over the last decade our understanding of how our skin ages has undergone a revolution. Whereas once the visible signs of facial and neck aging were attributed exclusively to skin laxity or looseness, today, we know that the sagging, drooping, wrinkling, textural alterations, etc that characterize the passage of time are a result of a number of anatomical and physiological events. These include loss in the quality and quantity of collagen and elastic fibers, largely due to years of accumulated sun exposure and other environmental damage; an increase in facial expression muscle activity (hyperkinesis); loss of facial volume (due to decreases in fat, bone, cartilage and muscle); weakening of the retaining ligaments that suspend and hold the skin and underlying tissues in place; and the fragmentation and downward displacement--due to the effects of gravity--of the fat compartments that are responsible for giving fullness, smoothness, and youthful contour to the face and neck. The result of this gravitational pull on compromised, devolumized facial tissue is that the face loses its youthful triangular shape and takes on a more boxy look as the jowls and neck sag. The presence of excess fat under the chin, the so-called "double chin" only makes matters worse.
To illustrate what happens to our skin as we age, just Imagine a fully expanded dining room table covered with a beautiful, smooth table cloth that hangs just so halfway down each of the sides of the table. Now consider what would happen if you were to remove both leaves from the middle of the table. Not surprisingly, the table cloth that draped so beautifully now droops down to the floor. To restore the table cloth to its proper position, you wouldn't conclude that it had gotten too loose and proceed to cutting it down all the way around the table to shorten it. You would simply reinsert the leaves of the table and voila. However, for decades, physicians perceived jowls and turkey necks and sagging cheeks to be simple laxity (skin hanging) and merely cut away the "excess" tissue" as part of surgical facelifts, necklifts and eyelifts--often creating artificial, cadaverous, skeleton-like, overly pulled tight faces--giving rise to the obvious and much dreaded, "They've been done" look..
Today, we can address many aging skin changes nonsurgically in a matter of minutes with little or no downtime. For muscle overactivity, we have neuromodulators, such as Botox, Dysport and Xeomin. For roughness, textural changes, skin dullness and mottled pigmentation, we have topical prescription medications, chemical peels, medical microneedling, etc. For fine wrinkles, we have fillers and for deeper furrows and volume loss, we have developed volumizing injectable fillers. And now, for sagging skin and apparent laxity, we have Nonsurgical 3D Vectoring Lifts.
A vector describes a magnitude and direction of force. Aging skin is characterized by a negative downward and inward vector of sagging. To counter this, surgeons traditionally pulled skin upward and outward--i.e. using a positive vector. The key difference between the outcomes of traditional surgical correction and nonsurgical 3D vectoring, both of which lift upwards and outwards, is the Nonsurgical 3D Vectoring Lift's additional corrective dimension of ‘forward projection’. This 3D effect is the result of volumizing with the use of injectable agents designed for this purpose, such as Radiesse, Voluma, Restylane SQ, and Stylage XXL.
The Nonsurgical 3D Vectoring Lift is predicated upon the fact that the face and portions of the neck differ in their degree of mobility. The region in the sideburn aread and extending downward directly in front of the ears is a fixed, denser, relatively immobile area, in contrast to the mid-cheek region (hence the greater tendency of this region to sag with the passage of time). These anatomical differences are exploited in the Nonsurgical 3D Vectoring Lifts by making the fixed areas serve as anchoring points for the mobile tissues.
In determining the positive vectors for the mid to lower face, the tissues that require lifting are identified by pulling the skin directly in front of the ears in a direction perpendicular to the area that requires correction. If the pulling results in lifting of the desired tissue, then the vector has been correctly identified and is then marked in accordance with 3D vectoring protocol. A similar approach is used in the region of the bone in back of the ear when dealing with neck laxity.
Once the proper vectors are marked, the volumizing agents are injected in a series of radiating bands that serve as support struts to the skin and that impart the necessary 3D outward projection--the lift--that distinguishes and defines this nonsurgical approach. The high viscosity and elasticity of the volumizing fillers serves to hold and re-support the overlying tissue and restore more youthful contours.
Although volumizing fillers are reabsorbed over time, they do promote new, native collagen synthesis, which may continue to provide structure, firmness and improved skin quality while continuing to lift tissues. A typical Nonsurgical 3D Vectoring Lift of the face takes about fifteen minutes to perform as does a 3D Vectoring Lift of the Neck. Bruising and swelling tend to be minimal, and most people can return to work or social activities immediately following treatment.
Bone loss in the chin bone (or a naturally recessed chin) can also contribute to a more poorly defined jawline. When necessary, volumizers can be used to achieve a nonsurgical chin augmentation, which serves not only to augment the ching, but to pull the jawline straighter and enhance the lift to the neck region immediately below.
A series of mesotherapy treatments treatment sessions (usually about four spaced at monthly intervals) can be helpful for dissolving fat from a "double chin" without the need for invasive liposuction. A product ATX-101 will soon be receiving final approval for use for this purpose. In my Israeli practice I have been using pharmacy compounded fat-dissolving solutions akin to AX-101 and another promising product, Lipo 101 (which, currently, is a few years behind ATX-101 in the FDA pipeline) in this fashion for many years with gratifying results.
Cheek Implants, Cheek Augmentaion, Cheek Enhancement, Cheek Fillers, Perlane, Radiesse, Chin Implant, Neck Lift
At 35 you seem a bit young to have a formal Neck Lift which is quite a lot of surgery. You chin seems weak and there is excess fatty tissue of your neck. I can't really see your Cheek but you stated they were flat. I also noticed that your Jaw Line is not prominent.
- Chin Implant
- Neck Liposuction
- Submental skin ellipse to remove some skin under the chin
- Cheek Implants
- Radiesse to the angle of your Jaw to create a more flared Jaw Line
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Options for lower face and neck
A neck lift is a far superior operation than just a traditional neck lipo. The neck lift will entail removal of fat both above and below the platysmal muscle, which is very important in the neck, especially in men. For a man with a short neck, it is important to adjust the digastric muscle as well. Tightening the platysmal muscle in front will give a definition of a new jaw line through a neck lift. Simple liposuction alone is not typically enough in this type of the neck.
Double Chin and Flat Cheeks, Neck Lift and other options
A full consultation will help determine your goals and the anatomical changes behind the picture. It is necessary to determine the best course of action.
However, options for excess tissue in the neck would range from closed liposuction to open liposuction with platysmaplasty to a face (neck) lift. One would obtain progressively more change with each option. At you age, you likely still have good elasticity in your skin, therefore your skin's ability to contract after a simple liposuction would yield some benefit to that procedure alone. However, it may not be satisfactory to you.
All of these options could be combined with a chin implant (augmentation), which would be of benefit not only to "strengthen" your chin, but also to increase the distance from your chin to the angle of your neck. This would be an aesthetic advantage as far as the double chin is concerned.
Fillers, fat transfer, and cheek implants would be what various surgeons may offer you for your cheeks. They each are associated with advantages and disadvantages. Fillers are temporary and have a relatively high safety profile. Fat transfer can be more permanent but assymetry is a possible risk. Similarly, cheek implants could end up being assymetric.
I hope this is helpful and of value for you.
Facial Plastic Surgeon from Irvine, Orange County Ali Sepehr, MD
Neck Lift treatments for patients under 40
Sagging, full, or fat appearing necks in younger patients may be improved via a few methods. Typically, there is excess fat and/or weak bone structure, which may run in the family. Neck liposuction with or without a chin implant are two less invasive options to improve the neck contour. A lower facelift may lift the neck and reduce excess skin, but generally not performed in those less than 40. Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you. Best of luck.
Chin Lipo Or Neck Lift And/OR Cheek Fat Transfer?
Very unfair to give you a definitive treatment plan based upon only one photo. My guess is a neck lift with submental lipo + Stem Cell + PRP fat to cheeks. From MIAMI Dr. Darryl J. Blinski
Radiesse works to augment chin and cheeks.
Of course, need complete evaluation, but you might have dramatic improvement just with deep fillers.
Double Chin, Flat Cheeks, and Small Chin what to do?
Dear Patient from Los Angeles,
Review of your photo without a physical examination reveals: excess skin and fatty tissue in neck area, small chin, and flat cheeks. You may be a good candidate for a neck liposuction and lift, as well as chin and cheek augmentation using fat grafting with PRP. Good Luck
The Lower Third of the Face: Necklift, Implant and Harmony
Be healthy and be well,
James M. Ridgway, MD, FACS