Well...what's next? Jowls, mouth laxity, issues related to gravity. (photos)
Doctor Answers (15)
Combination of skin elevation, SMAS tightening & volume enhancement will help. Consider anesthesia type for faster recovery
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.
Jowls, laxity, gravity
MCTs (Prejowl Sulci)
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A facelift may include buccal fat reduction to decrease heaviness in the jowl region
Facelift at age 47
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.
Face lift at 48
- 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.
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.
Facial laxity, jowls and pre-jowl sulcus
Younger patients like yourself benefit greatly from traditional facelift surgery and should consider this as an alternative to mini facelift procedures.