Mid Facelift, Mini Lift or Fillers for Marionette Folds and Slight Jowls at 37?

Dear missmagic73,

   I  have examined your picture carefully and here are my observations : Noticable jowls, hollow cheeks, deep tear trough grooves and downturned corners of the mouth.Fillers like Restylane can improve, but they are temporary and do not help the big picture outlined above. Fat injection are also limited in the total improvement. In my opinion, your best bet is a face lift based on the MACS lift technique ( developed in Europe by Dr Tonard from Belgium ). The procedure is very powerful because it uses deep sutures that lift the facial fat and muscles under the skin. It will do the followings for you : Fill the sunken cheeks by raising the jowls fat and famminising you face. Raise the corners of your mouth. Fill your tear trough groove and the hollowness under your eyes. Tighten up your skin. Be sure to select a board certified plastic surgeon who is experienced in the MACS lift technique.

                   Best of luck,

                                                Dr Widder

As a specialist in facial aesthetics and a board certified plastic surgeon, I hear concerns like yours quite often. As we age, we tend to lose facial volume, and in addition, the face (thanks to gravity) begins to fall forward and down. In women, this translates into a square, masculine jawline rather than the youthful, more heart-shaped face you once had. You will see the decent of the face manifesting in deep nasolabial folds, marionette lines, and an obscured jawline. In men, hanging jowls can descend to the point that they create a thicker, less defined neck that some call a “turkey neck.” As you are only 37, it would be unusual for you to have these issues in a profound way, but without a photos, it’s difficult to judge. If the vestiges of time have not done too much damage, you might want to hold off on a facelift right now, although facelifting is the most effective treatment for improving the lower face. You could consider a combination of minimally invasive procedures that would possibly include replenishing your midface volume loss by augmenting it with filler, possibly suspending the lower face skin with cosmetic threads, and tightening the skin with either a laser or microneedling with radiofrequency (RF). Depending on your anatomy, just one of these modalities might be effective. If your face has aged considerably, it is possible that these treatments combined together could help you to look much more youthful without surgery. Regardless, the important thing to do is to meet in person with a board certified plastic surgeon so you can be examined, and so that the best plan can be designed to create an effective approach.

During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect. If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. The LiteLift™ is an innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself which benefits many male patients. The goal of the #LiteLift is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.The technique requires limited incisions and takes a vertical lifting approach, in contrast to the traditional facelift, which requires extensive incisions and lifts or pulls the face towards the ears horizontally. The modern techniques used allow us to perform most LiteLift® procedures in the office under local anesthesia. Also, removing the risk of general anesthesia opens the door for more people to pursue facial surgery. All too often people do not move forward with undergoing the desires facelift surgery due to their overwhelming fear of the risks associated with general anesthesia.This is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. They also have a face and neck line beginning to sag, but whose skin has elasticity and whose bone structure is well definedOlder patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™.

Jowls can be caused by loosening of the face and neck from aging. The jaw line softens into jowls and fine lines appear on the corners of the eyes, forehead, and face. To define the neck, a chin implant is recommended in younger patients and a facelift in older patients (over 40). A facelift addresses the folds and jowls of the jaw. Liposuction of the neck and a mini facelift can be performed in younger patients. More so, a facelift or neck operation can help boost confidence while returning a more youthful appearance. The trend in facelifts is to have surgery at a younger age.

The treatment of facial aging
should be individualized based on the patient’s aesthetic goals, anatomic
findings and social situation.  No
two patients are exactly alike and because of this appropriate treatment
depends on the patients specific anatomic needs.  In your case, multiple options exist for correction of your
problem.

A mini facelift would address many
of your concerns.  This procedure
would address skin laxity, jowls and nasal labial folds.  Unfortunately this would require a
surgical procedure, significant expense, a recovery period and potential
complications.

In someone who’s only 37 years old,
a temporizing maneuver might be more appropriate.  In this case, injectable fillers might represent a solution
to your problem.  This approach
would need to be repeated at intervals, but would buy time and avoid surgery in
the short term.

Consultation with a board certified
plastic surgeon would be appropriate. 
This surgeon should be able to formulate an appropriate treatment plan.

I think some liposuction along the jowls and neck and fat grafting to the mid face would be a minimally invasive approach to improve the shape and volume distribution of your face.

Based on your photos it appears that you may be a good candidate for facial fat grafting or facial fillers (more so that a lift)

A mid-facelift is generally designed to improve the fullness and contour in the cheek area while minimizing any nasolabial folds (between the nose and the lips).  It does not address any early jowling. 

I believe that a mini-lift or traditional facelift is something that you might consider in five or more years.  In the interim, fillers are an excellent alternative that is less aggressive; this is sometimes referred to as a “liquid facelift”.

Based on the photograph I see, you have mild jowls, a moderate pre-jowl sulcus, mild nasolabial folds and mild to moderate loss of facial volume.  As other Surgeons have noted, there is not necessarily a right or a wrong answer, because fillers and surgical procedures achieve different goals; the best approach depends on what bothers you most, understanding that fillers will not lift the jowls.  Likewise, it would not necessarily be wrong to consider a combination of treatments. A mini-lift will help lift the jowls, while fillers (such as Radiesse) can address the nasolabial folds, while Sculptra can (gradually) replace the central and medial cheek volume.  I would not recommend a mid-face lift in isolation, because it will not address your jowls or marionette lines.  Good luck!

These procedures are not exclusive: they are complimentary: mid-face lift, mini lift and fillers. They all would help address the concerns you have. The mini-lift would benefit the jowls, the mid-face lift would help the loss of cheek fullness and fillers would soften the tear trough and marionette lines. However much could be accomplished with fillers.