Lower Face Lift: Q&A
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Do I Need a Lower Facelift?
I'm 44 and have noticed the oral commissure starting to drop. I have considered filler in this area but I'm not sure which one is better. I've been told that I need a lower facelift to eliminate jowls and tighten my neck, yet another consult told me I just needed filler. I just had a 20% TCA peel done 2 months ago along with IPL, Fraxel and Accent. I see no improvement from any of these modalities. I'm not sure what to think at this point because I'm not sure what I need done. Thank you.
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28 Doctor Answers |
Asked by
flower2010
in Maryland
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Lower Facelift versus other treatments
To some extent the answer depends on your goals. From what we can see on your single frontal photo, you appear to have some early jowling and laxity in your neck area. Along with your jowl, you are developing a perioral skin fold that extends from the commisure making your mouth look downturned. Your left side looks worse than the right, which is common.
It you want to correct the jowl and neck laxity then a facelift is really the only thing that can provide a good correction of both...
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Start Facial Rejuvenation With Small Steps
You might consider starting with a hyaluronin filler, like Juvederm Ultra Plus, for the creases around the mouth and fine lines of the lip. Restoring volume or judicious plumping can produce remarkably gratifying results. The fillers generally last about one year.
After trying the filler, if you are looking for more or different results, a Facelift (technique to be determined: mini, lower third, etc.) might be your next step.
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Face lift and fillers
If you analyze your face the oral commisure is good, BUT the perioral fold is hooding over making you look as if you have a down droop to the commisure.
You are starting with jowles and some neck laxity. Depending on how much this bothers you , the only option is a face lift.
Fraxel will not do any thing. Fillers will not raise the fold around the mouth on the left side. your right side is not as droopy
Baltimore Plastic Surgeon
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NEEEDING a Facelift
When you have a burst appendix, you NEED an appendectomy. When you have breast cancer you NEED a mastectomy. But - no one really NEEDS any cosmetic surgery. Cosmetic surgery should only be undertaken after careful consideration of all your options, from doing nothing to the simplest procedure on to the most complicated / risky procedure understanding that, just like dealing with stocks, the higher the potential gains / benefits the higher the potential risks.
Yes. You do appear to have...
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Lower facelift verses fillers for early signs of aging.
It depends on what you want to achieve. Radiesse will fill in the nasolabial creases and marionette lines. I have many patients that are quite happy with the results from this and they last 12- 18 months. It will not correct sagging skin: you need a facelift for that.
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Time for a facelift?
There are certainly signs of aging that a facelift and a number of ancillary procedures can help greatly.
The question, which only you can answer, is whether it is time for surgery or not.
We approach the marionette and corner of the mouth very differently than for a facelift alone, with grafting, DAO muscle division, etc. in addition to the facelift.
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Need for a facelift
You do have downward descent of the cheeks, jowl formation and neck laxity. All of these will benefit from a lower facelift. Fillers and skin lasers won't do nearly as much for you. Make sure to go to the best plastic surgeon in your area and check their photos extensively to see if the look they produce appeals to you.
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Fillers Rather Than a Face Lift
Looking at your photo, I see that your jawline is sharp, your neck is thin, and no bands are visible. For these reasons, I don't think you are ready for a face lift. A well-performed face lift is good at correcting the jowl and lower aspect of the marionette line, but does not fix the line near the corner of the lip. (If the face is "pulled" tight enough to totally smooth out this region, the lips will widen creating a "Joker Face" look.) I think HA fillers are best...
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Lower facelift vs fillers, peels and laser
Fillers will help but most likely - you need a lower facelift for optimal improvement.
The aging process involves 3 things ; downward decent from facial soft tissue laxity, skin surface aging characterized by wrinkles and discoloration, and loss of volume especially in the cheek area.
Failure to treat all three may make you more aware of what is not treated: in your case the lower commissures, marionette lines and jowls.. You only have already explored resurfacing. Volume...
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Is it time for a facelift?
Although it may seem artificial to compartmentalize your face, it is a useful exercise right now. If your primary concern is descent of the oral commissure, then I am not surprised that you are disappointed. The nonsurgical options you mention are all great for younger patients like yourself, but they are primarily aimed at improving skin texture. The options to improve descent of the oral commissure include Botox to the DAO, surgical division of the DAO muscle, a...
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Lower facial rejuvenation
I see 2 major options for you. One would be a lower facelift with incision around the ear up to the sideburn. Another nonsurgical option to consider is Sculptra. This treatment would fill the midface and secondarily lift the lower face, requiring 3 treatments in the office. This is an option you may want to research. I would recommend you see a Board-Certified plastic surgeon who has all the tools in the box, so you have a full spectrum of options available to you. Seeing you in person and...
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Weighing out your options
An aging face has numerous options depending on the overall outcome of the patient. Fillers are a great start. They can be used to fill areas that have volume loss. However I can see where you could benefit from a surgical lift, too. If this sounds too invasive, look into restoring your natural beauty by adding fat, which is a similar concept to fillers. I would have a sit down consultation with a Plastic Surgeon. They will be able to go over your options and answer questions regarding each...
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Fat grafting to substitute for early facelift
Your face could be significantly improved with fillers or preferably fat grafting which could delay your desire for a facelift for ten years. A facelift could be justified but you will need aggressive fat grafting even with a facelift to restore aesthetic contours. I hope this helps!
All the best,
Rian A. Maercks M.D.
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Lower face work
I use fillers all the time and do facelifts. I think that the two can compliment each other so that you do not look overdone from either one. You may only need fillers, but I could not be sure without examining you. It also depends upon what your goals are.
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Lower facelift does not address issues above the angle of the jaw.
It is no surprise that the Fraxel, pulsed light, and the others have had no effect. In my opinion, you would be an excellent candidate for a full faclift (lower eyelids down to the sternum). It will fix the marionette lines, change volume distribution in the face, fix the sagging neck, and establish a straight jawline. Furthermore, your skin seems to be in excellent condition so you should expect an excellent result.
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Lower facelift will improve the overall appearance of your jawline and neck
Patients today have many options for facial rejuvenation of the lower face. Dermal fillers are extremely popular in patients that want to correct the nasolabial folds and marionette lines (otherwise known as the smile lines). Dermal fillers also worked extremely well around, the commissures of the mouth. If this is your main concern, a dermal filler may do the trick.
If you're interested in changing the shape of the jaw or in redraping the skin on your neck, a lower facelift will...
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Choosing a facelift depends on your goals
Facelift procedures correct sagging tissue in the neck and jowl area. Injectable fillers provide additional volume in the nasolabial folds and marionette lines. The two procedures may also be used together to good effect. A consultation with your chosen surgeon should specifically address which aspects of your face cause you the greatest concern and only then address the specific procedure(s) needed to acheive the desired results.
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Facelift will provide maximum improvement for skin laxity
It really depends on how much improvement you want.
You could have a non surgical Thermage procedure for some "lift" or even liposuction to help soften the jowl area.
If you want to go "all the way" for maximum improvement, then it appears that you have enough laxity for a facelift.
see video
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Management of Lower Facial Aging
Hi there-
When jowls begin to form, the corners of the mouth begin to turn downward, and the upper neck skin starts to sag a bit, fillers may camouflage the changes a bit, but will usually leave you dissatisfied.
Similarly, skin treatments and laser procedures will improve the appearance of the skin, but won't improve the changes in the shape of the lower face you are noticing.
Your best bet is to find a reputable surgeon certified by The American Board of Plastic Surgery and...
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Lower facelift with neck lift may help
Looking at your picture, you do have some lose of volume or fat from the cheek area. Your skin quality is great. You have a mild degree of jowling which is asymmetrical and more significant on your left. You also have a small mild degree of neck laxity. To correct these issues, I would personally recommed a lower facelift with neck lift to correct for the jowling and the neck. For your cheeks, I would perform fat transfer to give you more malar (cheek) fullness.
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Early signs of aging
You are displaying the early signs of aging. You have several options available depending on what you want to achieve. Early jowls can be treated with a lower minimally invasive facelift (minilift). The results will be there, but subtle. Another option is fat transfer to your developing marionette lines, nasolabial folds, and the the area just in front of your jowls. The prejowl fat transfer will provide you with a more smooth and continuous jawline and buy you time until the jowls descend...
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A lower facelift
From your photo, I would do a short scar face lift with Stem Cell Fat Transfer Enhancement (Giampappa technique) in a combination.
Regards from MIAMI
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Correction of lower facial laxity
In my opinion correction of your problem is best managed with a lower facelift and consideration of fat injection to the periooral areas including the labiomandiblar line and oral commissures.
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Facelift: It's Up To You
The question regarding "need" for a Facelift is a frequent one in my practice. My definition of whether a patient qualifies depends on two factors: indications (jowls, platysmal bands, neck laxity) and desire to have these changes addressed. Based on the photographs, the indications are present, the question is: Do you want it? Processing the concept of surgery can be difficult and it is not unreasonable to wait and have fillers.
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Fillers restore youthful volume, facelifts elevate sagging tissues
There is no one answer for an aging face. Fillers can be used to fill narrowing cheeks and even camouflage jowls. However if you have more than mild jowls, the lower face may look too full if filler is used around the jowls. In that case you may need a Facelift. We often use fillers and/or fat with facelifts to address both in one procedure.
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A facelift will enhance your neck and jowls
From the sounds of your question you have already spent a significant amount of time money and energy and are not happy with the results. Without an examination it is hard to suggest different procedures to address the areas of concern for you, however in general I would suggest starting with the mid face either by adding volume through a cheek implant (fillers or solid silicone) and lifting the mid face to address the cheeks decent and the oral commisure.
A Facelift is usually how I...
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Marionette lines are tough to fix with any treatment
I have found the slight downturn of the mouth to be a very difficult area to treat completely. Facelifts will help the jawline and neck but are typically very poor for a slight mouth downturn. The types of facelifts that get aggressive and get near the mouth I believe can create more distortion there than benefit.
Overfilling this area can also be a problem. You must be conservative with fillers and possibly even segregate the sessions to get the area turned up. I...
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Face lift
The down droop of your commissure can be help with a few units of Botox but the jowl area is best corrected with a lower face procedure. A good experienced surgeon can achieve a good result in your case.
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