MDSkin Lounge - Old Town

Based on the photos submitted, ideally I’d recommend a facelift/neck lift with facial fat grafting. You may also benefit from an endoscopic midface lift as well, or this can be done separately. This plan will give you the most natural and comprehensive approach to address you jowls, neck contour as well as your cheek shape and lift

A facelift in a younger patient isn’t taboo, as much as it is typically not needed in younger patients who don’t have the skin excess to warrant the surgical recovery and scars (although hidden). Still, in patients that have enough skin laxity/excess which can be genetic, or related to weight loss, a facelift is definitely an option on a younger patient. I think that it is somewhat taboo, simply because traditionally most facelift surgeons would tell a patient to wait or seek non-surgical options first.

Jowls are a normal and often have a genetic component of most faces that in time drop and lead to poor neck and jaw-line contours. Facelift and fat transfer can improve jowling in most patients. An endoscopic midface lift can sometimes improve jowls, but mostly improves the cheek and lower eyelid areas. Other than facelift, you may consider facial injectables like Volux to improve and reshape the jawline and chin. PDO threads may help as well. In our practice we offer a minimally invasive option for jowl call face-tyte.

Based on your age and your photos I would not recommend a standard facelift yet, as you don’t have enough lower face and neck laxity to warrant the incisions and scars. However I do believe that you should consider other nonsurgical options to better volumize and restore youthful facial shape. Your photos show a more “square” facial shape with some jowling. Any surgical or non-surgical plan should focus on ways to achieve a natural ovoid or heart-shaped youthful facial contour and to stimulate collagen and naturally lift. I would consider Dermal fillers, sculptra, or facial fat grafting to restore facial volume and shape focused on adding volume to your outer cheeks/temples as well as your central chin to reduce the “square” appearance. Although its difficult to see on your straight photograph, you likely would benefit from jawline filler to help improve your jowls. PDO threads, Morpheus8, or ultherapy could also be useful to tighten skin and lift without surgery. Finally, if you were interested in a more permanent options I would consider and endoscopic midface lift with facial fat grafting(pony-tail lift).

You are absolutely correct in noticing that the majority of facelift results don’t really show much improvement in the marionette lines because facelifts generally don’t affect much change in this area. A standard SMAS facelift will significantly improve the neck/jawline and show some improvement in the cheeks and midface depending on different techniques used such as fat grafting, midface lift, or high smas lift. Still, the deeper marionette lines you are referring to are present both because that is the normal insertion of the smile muscles and because there are ligament attachments in this area that are not released during most facelifts. Some Deep plane facelifts and midface lift techniques as well as standard facelift techniques that more aggressively release some of the more “central” ligamentous may better soften these lines, but they will never completely go away as they are part of your natural facial shape and smile/animation. I will treat these lines with a combination of dermal fillers, facial fat grafting and a midface lift, but still tell patients that they will not completely go away with any technique.