Do I need some aspect of a facelift or will fillers help? Early 40s. Jowls bother me a lot (Photo)

A person’s age is best guessed by the appearance of their face. If you feel that your face does not reflect how young you feel inside, you may be a candidate for a facelift.During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are patients 35-60 years old with early changes of the lower face and the neck. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. Lite Lift™ surgery is individualized for each patient. The best candidates for Lite Lift™ surgery have a face and neck line beginning to sag, but whose skin has elasticity and whose bone structure is well defined and do not smoke.

This is a very common issue particularly for a lot of women in their
40s. There are basically two aspects of facial aging that you are experiencing:
descent or sagging, and volume loss. Descent
or sagging where the skin and soft tissues are sagging or drooping. This is
partially responsible for the jowls and the little band of skin below the chin
which has resulted in a loss of angularity. The other part is volume loss that's
the gradual diminishment of bone, muscle, fat, skin and soft tissue.



For years, there have been debates between non-surgeons and surgeons
about the better procedure for facial aging. Before deciding a procedure, I
often ask patients to do a simple test, and this is by physically lifting the
skin upward and seeing what happens to your jawline and neck. This is often
referred to as a mirror lift. This is literally moving tissue upward to see if
it improves your jawline and neck. If it does, a significant element of your
concern, specifically the jowls, is related to some descent.



Usually, when someone has this type of situation and they are
relatively young as you are, then a limited incision face lifting procedure can
be considered. In our practice, we do these procedures under local anesthesia
with LITE™ IV sedation. It’s still not a shortcut procedure because deeper
tissues, specifically the layer called the SMAS or superficial
musculoaponeurotic system, needs to be addressed in order to maintain the
position of the skin. Unfortunately, a lot of doctors advocate deep plane and
other lifting procedures. However, an experienced cosmetic surgeon who does a
lot of facelifts will customize these procedures based not only on the external
physical exam but also what they see when doing surgery. A lot of decisions
have to be made in real-time during surgery depending on the quality of the
tissue and the effectiveness of the movement. I think that repositioning
sagging tissue is probably the most optimal way to restore a youthful
appearance when there is descent.



In our practice, we periodically also do fillers to restore volume.
Sometimes we do this when patients don’t have the time yet to do a facelift. In
the meantime, we do things to soften the appearance of the jowl using fillers
like a material called Radiesse. We routinely put it in an area that is right
in front of the jowl called the mandibular notch. Adjacent to that is the area
called the mesolabial fold which is often referred to as the marionette line.
These areas benefit from augmentation or replacement of some of that loss of
volume. Ideally, the sequence would be to lift and then add volume. When the
face is thin, there are opportunities in different areas to restore volume. My
approach is to always be conservative. I want to restore
just enough so that artistically, the balance of your face is maintained.



I think that you would benefit from meeting with experienced cosmetic
surgeons. In my practice, we offer everything from advanced surgery to skin
care products and everything in between. We are able to customize a plan for
each patient. With 20 years of practice, I always try to figure out ways to
create the right solution for the right time to match the person’s desires and
budget. I hope that was helpful, I wish you the best of luck, and thank you for
your question.



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From the photographs it looks as though the facial aging is very modest. I think you can get a good result with fillers. In the end however it depends on your expectations. Consult with the plastic surgeon who is experienced in facial aging.