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Well...what's next? Jowls, mouth laxity, issues related to gravity. (photos)

Need some advice. I am 47 soon to be 48 years old. I am feeling great, but years of running, lifting, KIDS, have taken its toll:) I recently had a BA, and it turned out great. Now on to the face. I would like to do something to remove the jowls, mouth laxity, and issues related to gravity. I had a filler placed in marionette lines in June. I also had a neck lift 5 years ago. It helped with jowls for a bit, but now they are back. I intend to have several PS consults in 2014 for my face.

Doctor Answers (15)

Combination of skin elevation, SMAS tightening & volume enhancement will help. Consider anesthesia type for faster recovery

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As a cosmetic oculofacial plastic surgeon and someone who specializes in facial aging, the challenge that is seen in my office everyday is making decisions on how to deal with the two factors that are related to the genetics of facial aging: volumetric loss or volume loss - the loss of bone, muscle, fat and soft tissue; and descent or sagging that requires a procedure involving lifting.

A facelift is a procedure where the cheeks are elevated from the cheekbone down to the jawline in a predominant vertical direction. It’s basically a combination of vertical and lateral or posterior directions but a significant part of face lifting is to move sagging tissues upward. The necklift procedure deals with the banding of the skin of the neck that is sagging and tends to be more posteriorly oriented.

When we do an isolated necklift for a patient, I first do a very thorough discussion. I let the patient understand that the combination of jowls and sagging skin in the neck area is often contributed by both the descent of the face as well as the sagging of the skin and loosening of the underlying soft tissue of the neck. That being said, a facelift procedure for you would involve some type of skin elevation as well as tightening of the underlying structure called the SMAS (superficial muscular aponeurotic system).

There are a number of types of facelifts that are being marketed, examples are: deep plane facelifts, extended SMAS facelifts, high SMAS facelifts, SMASectomy and composite facelifts. In addition, when you look at the history of face lifting surgery in the cosmetic surgery field, there are many techniques. All techniques are valid but they also depend on the individual surgeon.

When I meet with my patients, I discuss what their desired outcome is and what it will take to get to that desired outcome. We do all those procedures I just mentioned. All those things in the hands of an experienced surgeon like me can be performed and customized. When you are choosing a surgeon, what I always recommend is that you have to have very good communication and a clear understanding of your desired outcome.

Surgeons would often focus on what the surgery can do for patients, but in my practice I focus on developing a comprehensive plan and identifying the areas of the face that can’t be addressed by face lifting alone but rather by a combination approach. Sometimes we will combine things at the same time with the facelifts such as facial implants like cheek implants or chin implants. Sometimes we will combine fat grafting and other modalities to maximize what we can do surgically and what we can do that would overlap the surgery. You have to come up with a plan where sagging and volume loss can both be addressed to maximize the appearance. As you enter the late 40s and 50s, there is going to be some maintenance that is going to be necessary that won’t be necessarily surgical.

I find that a lot of people are not aware that you can do these surgeries under local anesthesia with LITE™ sedation. We actually trademarked a name LITE™ anesthesia because in our practice, we developed a system to do all these procedures such as: eyelids, facelifts, liposuction, tummy tucks and breast augmentations all under local anesthesia with light sedation. I’m not saying that general anesthesia is not appropriate, but we find that in the spirit of quick recovery and better patient experience, we are doing full extended face and neck lifts that are the same as the procedures done under general anesthesia. A very important factor is that these are not shortcut procedures - it's important to add this into your questions as you make distinctions between doctors.

At this point, you’re going to have meetings with some qualified experienced cosmetics surgeons and you should make sure that you feel that you are in sync with your doctor. Both of you should communicate well and you are comfortable with the type of procedure that is being recommended. I hope that was helpful, I wish you the best of luck, and thank you for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 27 reviews

Jowls, laxity, gravity

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Hello, your question is a good one and very common!  There are options to address your concerns. Some are more involved and some are less as you can imagine.  From what I can tell, you have a very good bone structure to the face, including, chin, cheeks, jawline and position of the hyoid bone (in the neck).  Depending on skin type, thickness, degree of laxity etc a more classic and time-honored procedure would in my opinion give you the best result for the longer term.  It is difficult to give a more accurate opinion without an actual evaluation however. 

Michael A. Carron, MD
Detroit Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

MCTs (Prejowl Sulci)

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The pointed chin is effecting the facial aesthetics. The easiest and quickest treatment is a filler (my choice would be Radiesse) in MCTs (Marionette Chin Triangles) also called Prejowl Sulci. 
Regards
Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

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A facelift may include buccal fat reduction to decrease heaviness in the jowl region

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From the photograph it looks like pruning of the buccal fat pad might improve the sculpting when accompanied with the facelift. You should be an excellent candidate for facelift in that you have attractive features, what appears to be good quality skin, and aging changes that facelifts generally do a good job with.

Vincent N. Zubowicz, MD
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Facelift at age 47

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Thanks for sharing your photos.  You appear to be an excellent candidate for facial rejuvenation. Signs of facial aging varies from patient to patient, and it is very important that your plastic surgeon carefully examine your face to individualize your surgery.

A very significant improvement in facial shape and transitions is possible to give a youthful and natural result. In my practice I am now frequently seeing patients with some jowls and loss of midface volume and projection seeking facelift in their 40’s. I think as we have learned about facial aging and its signs we now recognize these issues sooner and patients are more comfortable with the treatments.

The results of a facelift in this age group lasts for many years. I recommend a consult with a board certified plastic surgeon with experience and dedicated interest in facelift surgery.  

Steven M. Camp, MD
Fort Worth Plastic Surgeon
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Face lift at 48

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  • you look great for your age,
  • a lower face/neck lift will remove the signs of aging that you do not like,
  • if you are having surgery, don't have more fillers.
  • Consider some fat transplants with your face lift surgery.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
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Facelift before 50

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Facelift before 50

You are an excellent candidate for a well performed lower facelift. Facial aging varies from patient to patient, it is imperative that the surgeon carefully examine your face to individualize your surgery. A well executing facelift can produce a dramatically rejuvenating, and yet very natural result. In my practice I routinely perform facelift in patients in their 40’s. The results of a facelift in this age group lasts for many years. Interview a few surgeons with reputation for excellence in facial surgery. The office should be able to provide a large number of before and after photos of patients with similar facial aging as you have.

Boris M. Ackerman, MD
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Facial laxity, jowls and pre-jowl sulcus

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Photos show significant pre-jowl sulcus present in addition to  jowls and facial laxity. A mini lift with a pre-jowl Silastic implant should address facial changes of aging that you're concerned about. For many examples please see  the link below to our facelift photo  gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Sagging Jowls

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The lower face would benefit greatly from a deep plane facelift with platysmaplasty, some liposuction of the jowls, and a pre-jowl sulcus implant or at least fat grafting in this area to improve the mandibular rim.  I would strongly conside a lower eyelid blepharoplasty to tighten the lid, elevate the muscle slightly, and remove a small amount of skin.  Laser resurfacing would improve the overall skin envelope  which has aged due to environmental and lifestyle stresses.  Although this may seem like more surgery than you currently think you need, this procedure has significant longevity ( 10 years) and will significantly rejuvenate your face.

Younger patients like yourself benefit greatly from traditional facelift surgery and should consider this as an alternative to mini facelift procedures.

J. Kevin Duplechain, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

What are options for my face?

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The two most apparent issues to address appear to be slight jowling and loss of volume. A mini-facelift would address your jowling and create a more defined jawline. Volume replenishment can be accomplished with dermal fillers such as Juvederm, Restylane, or Sculptra. Fat transfer is a fantastic option however, if you are an athlete there is a chance that you may not have a lot of fat to transfer. Consult with an experienced facial plastic surgeon for more options.

Todd C. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.