Which procedure would deliver the best results for targeting the jowls? Previously had a mini facelift and Restylane (photos)

Question

I have had a mini facelift 2 years ago that I never really seen a difference. Thennow I have a lot of restylane. Which made a difference. I have an underbite so I am thinking maybe this has something to do with it. What do you think would be the best thing for me to do to make a big difference.

Suleyman Tas, MD, FEBOPRAS · Answer

Dear whodeewho1,

Thankyou for providing pictures for a better recommendation. I recommend you to have a full facelift and neck lift surgery with fat injections to give you a tightened lifted and younger appearance. I am attaching a link for before and after if you would like to look deeper into the procedure and what to expect.

Regards,
TAS TEAM

Donald Groves, MD · Answer

Hello and thank you for your question. From what I can tell based on the pictures you have provided, there is some moderate jowling present on both sides and some prominent nasolabial folds. This occurs with age as the soft tissues of the face start to descend and as we lose volume from fat atrophy and bone loss, resulting in the characteristic changes of facial aging. You also have rhytides (wrinkles) present throughout your midface, lower face, and neck- especially noticeable around your mouth. This is a result of skin damage and laxity which occurs with age. You have some excess neck skin but I cannot tell if there is any platysmal banding in your neck. Based on all that, I would definitely recommend a revision facelift/necklift for you. A facelift would be the best way to address the soft tissue descent and jowls to improve jaw definition and restore a more youthful appearing face and neck. It would also help remove some of the excess lower face and neck skin which is contributing to all the wrinkles. At the same time, facial fat grafting can also be done to address volume loss and help further improve facial balance and harmony.
I would want to see how everything looks after you heal from the revision facelift. From these limited pictures, it looks like your skin would likely also benefit from laser resurfacing to really give you the best possible results, but I would NOT do this at the same time as the facelift. When you perform laser resurfacing, you damage the skin from above, as you remove some of the outermost layer(s) to allow new, better quality skin to heal in from below. As a result, when you perform both a facelift and laser resurfacing at the same time, you are introducing insults to the skin from both above and below, further stressing/compromising the vascularity, and increasing the risk of skin/wound complications (e.g. delayed/poor wound healing, skin ischemia/necrosis, infection, etc). 
With all that said, it is difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos you have provided. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Keith Hodge, MD · Answer

To treat the wrinkles around your mouth a would suggest microneedling, profractional laser resurfacing or an ablative laser resurfacing which is more aggressive with more downtime. Regarding the jowls, I would suggest a deep plane facelift which is the most powerful lift of the medial cheek and jowl area. Good luck!

Gianfranco Frojo, MD · Answer

I would recommend a deep plane facelift/necklift with perioral chemical peel/fat grafting to address your concerns. Best of luck!

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. You may benefit from a facelift procedure to remove the excess fat in the neck and jowls along with excess skin to create a smooth appearance. The underlying muscles can also be tightened to provide natural, long-lasting results. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to review your surgical history and determine the best procedure to help you achieve your aesthetic goals.

Brian Biggerstaff, MD · Answer

Hello whodeewho1, a facelift/necklift lift (either SMAS facelift or deep plane facelift) will be much more effective than fillers at improving your jowls and giving you more definition of your jawline, and will improve the appearance of your neck as well. It is difficult to know what technique or the extent of your initial mini-facelift procedure, but typically with a full facelift (including a SMAS procedure) you would notice immediate improvement in the jowls. Thus, you would likely get the best improvement with a secondary facelift. Hope this is helpful. Thanks, Brian

Richard G. Schwartz, MD · Answer

Based on your photos, I suggest a standard facelift or at least a short scar facelift targeting the entire cheek region with a more vertical lift including a SMAS advancement.  I often also perform conservative liposuction in the jowl area to reduce fullness.  However, if you have a significant underbite and your lower jaw is small, that could limit results.

Derek Fletcher, MD · Answer

I need standard photos (front, oblique, side, and side with chin down) to give you the most accurate assessment. However, base on what I can see, you would benefit form a combination of facelift, neck lift, and skin resurfacing (fractionated CO2 or deep peel). Most patients benefit from facial micro fat grafting as well.
There are many facelift techniques. The operations with the longest lasting results are rarely "mini" procedures. An in person exam is necessary to determine which combination of techniques is best for you.

Maribel Belmontes Castillo, MD · Answer

In facial rejuvenation techniques, the mini facelift is one of the most conservative techniques with minimal results, only remove the extra skin. The most current technique that offers the best results is the deep plane technique, where work is done below the SMAS, the ligaments are released and the tissues are advanced, allowing the muscles to be repositioned, offering natural, long-lasting results

Brian K. Machida, MD, FACS · Answer

At this point, you need a facelift which is not a mini. A SMAS lift or deep plane lift should address your concerns

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