Effective and Long-lasting Procedure for Lifting Jowls?

Effective restoration of the face which is done with a “Lift & Fill” facelift where the central facial and malar deep fat compartments are filled with your fat and then the deep layer SMAS is used as an anchor to lift the deep layers of the face, This facelift has longevity and allows for a natural, youthful result.

The correction of the aging perioral area is more complicated. If there are deep folds around the lips (commissures) then the facelift will help with deep nasolabial folds. If there are deep creases as well as fine perioral wrinkles, then a facelift with fat compartment lifting, and filling, as well as laser resurfacing are in order.

In summary,

• If there are jowls with extra skin and deep nasolabial folds, then restoration using the “Lift & Fill”
SMAS facelift is essential.

• If there are deep creases in the corners of the mouth and deep perioral wrinkles, then deep fat augmentation of the commissures, Juvederm injections to the lips, and perioral Erbium-type laserbrasion works well.
 

The best option for correcting the jowl is a Facelift and the best Facelift technique for the jowl is the vertical Facelift. This procedure requires an extended skin elevation to the corner of the mouth so that the full extent of the jowl can be seen. Then the excess fat can be directly excised and the sagging tissue can be lifted upward instead of backward ( like seen with the more typical SMAS lift or deep plane face lifts).

There are many options and there is no one right answer. It may depend on your "appetite" for correction.

As you have had restylane, you are now familar with what we would call a camouflage procedure. These are interventions that compensate or mask the signs of aging without necessarily correcting the problem.

The jowls are a difficult area that are effected by the size and shape of the mandible (jaw bone), fatty deposits of the skin and buccal fat pad, skin and muscle laxity.

Other fillers are available such as Radiesse, Juvederm, Perlane, Sculptra, etc.

Skin tightening modalites such as Thermage, Titan, Accent, etc tend to use energy (radiofrequency) to contract the skin. This has met with mixed success and while some patients have demonstrated benefits it is difficult to achieve predicable consistent results.

Laser assisted lipolysis such as Smart-lipo, Cool touch, etc use a very fine laser cannula to destroy the fat and supposedly contract the skin but this is not a widely held belief among plastic surgeons.

Fat removal (open surgical excision of the neck or buccal fat extraction) or via liposuction is may provide you with some benefit especially in reducing the localized fullness in the neck/chin area.

Face lifts may provide you with the maximal benefit but tends to involve greater risk.

Adjunctive procedures such as a prejowl implant can also provide some enhancements in this area of your face and would achieve what the restylane accomplished on a more long term basis. Alternatively, you could consider lipoinjection in the prejowl area.

Dear Barb,

     You recieved a great number of answers to your question and quite extensive procedure recommendations. You say that you have good skin and I agree. Consequently, based on careful examination of you pictures,  I would recommend liposuction of your neck and jowls, and platysmorrhaphy ( removal of fat from under the platsma muscles and tightening of the muscles ). That procure will improve your appearance dramaticaly. If you want to improve also on your Marionettes ( the folds under the corners of the mouth )  , a neck skin tightening will do it.  Be sure to select a board certified plastic surgeon who has experience in facial cosmetic surgery.

           Best of luck,

                                  Dr Widder

Web reference: http://widderplasticsurgery.com

Facial Jowls generally result from the descent of facial fat with age, causing the accumulation of tissue that makes the jawline appear less defined.  Soft tissue fillers provide a "back-door" treatment by filling areas around the jowls, making the jowls seem less prominent.  The best long lasting and most controlled treatment of jowls is a facelift using the SMAS layer to re-suspend facial fat to its youthful position at the cheekbones. 

Looking at your photos, my first question would be whether you are at your optimal body weight.  If you are a bit heavy, jowls can seem larger and the entire face fuller.  Weight loss can help these areas, but then you have to consider what your skin elasticity is like, and whether you will have to deal with extra hanging skin should you indeed lose weight.  If you are at your target weight, then I would proceed with the aforementioned facelift technique.  The facelift procedure addresses the lower two-thirds of the face, that is below the eyes including the neck.  Often a small amount of liposuction of the neck can be added to the facelift to further define the jawline and help make the neck appear more graceful.

Best of luck.

I do not think that facelift surgery is the only option for the correction of jowls. It is just one of the techniques that can be used. It is important to remember that jowls can be caused by multiple conditions such as gravity pulling the jowl tissue down, selective fat atrophy or loss of fat in the face which produces an indentation in front of the jowl making the appearance of the jowl worse as well.

The techniques of filler injections around the jowls do not really fix the jowels themselves but try to camoflougue the pre-jowl sulcus. If the patients skin tone is adequate and they are not a candidate or do not   desire facelift surgery an improvement in the jowl shape can be achieved by a small amount of  liposuction, laser liposuction, or of injection of lipo dissolve.

I realize that the idea of using lipo dissolve is not very popular today, however it is absolutely remarkable how effective one or two injections can be in the small areas of fat collection. Sometimes to improve the appearance of the jowl and some what mimic an effect of a facelift in that area the release of the mandibular ligaments can be performed under local anesthesia.

For patients that have skin laxity in that area especially in front of the jowl, facelift surgery even with SMAS can be effective, however good results can also be achieved with an aggressive peel in the perioral area.

I think that there are a variety of techniques available for jowl improvement. Minimally invasive to very invasive. The key is to make sure that during the process of improvement for the jowls you discuss with your surgeon more then jnust the jowls and create a comprehensive plan in improving your facial appearance. This way you have a plan of action so to speak that would usually include a skin care regimen, lasers, peels, facial surgery and maybe even hormonal modifications.     

I would recommend neck and jawline liposuction, buccal fat pad excision, and a short scar facelift with MACS lift technique or Lateral SMASectomy.   This procedure results in a 7-10 day downtime, requires use of a neck/chin strap garment x 2 weeks.  It can offer substantial correction to your concerning jowls, yet provide a natural elegant result.   

Looking at the photos you supplied leads me to recommend you undergo a facelift.  Jowling is the result whenever there is descent of the lower facial tissues due to gravity, aging, loss of skin elasticity etc...Jowls go hand in hand with the lines you describe from the corners of your mouth; these are referred to as marionette lines. A filler should be thought of as a form camouflage for various lines and folds. Fillers do not provide 'lift' in the same way that a surgery would.

If you had a facelift the jowls would be treated by:

• lifting the internal muscle fascia layer
• possibly trimming the jowl fat
• tightening the facial skin

By being able to reposition the descended tissues and addressing multiple layers, the jowl correction from surgery is generally much better than with fillers.

I recommended a facelift partly because you appear to also have a 'double chin' in the lateral photo. The facelift takes care of the neck, as well as the jowls and cheeks. Alternatively you could have a mini facelift- a procedure that will take care of the jowl and cheek region without direct improvement to the neck.

As with any procedure, the first thing a surgeon needs to do is make a correct diagnosis.  The jowls usually are caused by normal aging of the face, but in some individuals there is an additional component that causes jowls, and that is buccal fat.  If that is not addressed than the results of a face lift will be sub-optimal, of course removing buccal fat in a wrong patient will also cause sub-optimal result.  As for the type of face lift,  the surgeon needs to address deeper structures during the face lift to correct jowls. Once again, individualized approach is paramount to obtain great result.  An experienced and talented surgeon will explain to the patient the ideal approach to correct jowls.

Addressing the relaxation of the SMAS (Muscle) as well as the fatty tissue relaxation in the jowl area will give you the longest lasting results.