Michael Ondik, MD

The jowls are composed of fat, muscle and skin that descends downward along the jawline  as we age.  Early on the jowls may be very slight and can even be camouflaged by injecting filler materials (such as Juvederm) in front of and behind the bulging tissue.  At a certain point, they can only be effectively corrected by doing a surgical procedure.  The terminology can be rather confusing, but the best procedure is a "facelift".  A facelift will correct the jowls by repositioning them back to their natural position.  The excess skin is removed at the same time.  The incisions typically curve around the ear and are hidden very well.  The exact type of facelift will vary depending on the severity of the jowls and also whether there are aging changes in the neck area (in which case a neck lift should be included).  The longevity of the lift will depend on multiple factors, including the exact technique used, the elasticity of the patient's tissues, weight gain and other factors.  Assuming the proper procedure was chosen and performed correctly, the jowls will slowly reform as the years go by, but they should not reach the severity present before the facelift.

Eye bags below the eyelid are most commonly due to fat from the eye socket that has bulged out and is pushing on the lower eyelid skin.  The best way to treat this fat is to remove or reposition it so that it no longer bulges outward.  The surgery to do this is called a lower blepharoplasty and the incision can be made either on the skin, slightly below the lashes, or on the inside of the lower eyelid.  In either case, the fat is carefully excised, or repositioned further down (so that it may help pad the bone at the base of the eye socket).  These maneuvers will help create a smooth transition between the lower eyelid and the cheek.  In some cases, it may also be necessary to remove a small amount of lower eyelid skin, but this should be done very cautiously.

In less severe cases, eye bags may be corrected by injecting a filler material (such as Restylane) into the area just below the bag.  This does not permanently fix the eye bag, but it does camouflage the bag and help create a smoother transition between the lid and the cheek.  Results typically last 12-18 months.

Finally, less severe wrinkling of the eyelid may be improved by laser resurfacing of the lower lids.

It is difficult to give a detailed analysis based on one photo, but you do not appear to have ptosis.  Ptosis is when the eyelid margin (basically the edge of the eyelid) hangs too far down relative to the pupil (the black part of the eye).  This distance appears to be nearly equal in your photo.  Your asymmetry appears to be related to the eyelid crease and the brow.  Determining between these factors would take a good physical exam before recommending any treatment.

The last decade has seen an explosion in the variety of cosmetic lasers.  The sheer number of manufacturers and types makes comparing treatments very difficult.  Furthermore, even a simple term like "resurfacing" may be used in many different contexts.  I typically think about resurfacing in terms of 3 different types of technology.  The first is IPL (intense pulsed light) or BBL (BroadBand Light).  IPL is not strictly a laser, but it tends to be lumped into the laser category.  IPL is great at treating brown or red spots.  Many patients have accumulated many brown pigmented spots on their face, neck and upper chest and the IPL is very effective at reducing these spots.

The second type of technology consists of lasers that remove one or more layers of skin, leaving the deeper layers to regenerate and produce more youthful skin.  Removing the topmost layers of skin is great for creating a smoother complexion and treating fine wrinkles.  Removing deeper layers will treat deep pigment and deep wrinkles.  The "cost" of treating deeper layers is a longer downtime.  These lasers may be CO2 or Erbium.  There are advantages and disadvantages to each.

The final type of technology is the fractionated laser.  The fractionated laser creates a grid, leaving a large portion of the skin untreated (unlike the previous laser that covers the entire surface of the skin).  There are two advantages to this technology.  The first is that leaving so much intact skin speeds healing time.  The second is that this laser can go very deep and stimulate collagen growth which leads to skin tightening.  The main disadvantage is that more treatments will be required.

I usually customize a plan for each patient that incorporates two or more of the above technologies.  At the end of the day, you need to work with a physician that understands the pros and cons of each technology.  Then you need to decide on a treatment goal that respects your budget and downtime.

The jowls are a combination of skin, fat, and muscle that forms as these tissues descend down along the jaw line over time.  Most facelift techniques are focused on repositioning these tissues back to their original location.  The SMAS is a layer of muscle and fat beneath the skin that is essential to correcting jowling.  The SMAS is typically tightened and "lifted" into higher position so that it no longer sags down, creating the jowl.  Without getting too technical, this can be accomplished using a variety of techniques (hence the wide variety of facelift types).  Any excess skin will also be removed (with the incisions hidden around the ear).  The end result is that the lower face will be less heavy and more youthful.