Is non-surgical Facelift my best option? (photos)

Question

I had a consultation for Kybella & Coolsculpting for my chin/neck and was told these would not work for me as it is not fat. I was told I need upper and lower face botox every other month for $1,200 per session and Juvederm once a year in my cheeks for $4,000. I believe this is called a non-surgical facelift. Is this my best option? My goals are less fullness in my neck, jowl tightening, a more defined jawline and chin, fuller cheeks, and more fullness under my eyes. What is my best option?

Daniel Barrett, MD · Answer

Dear s_ferrari,
Kybella typically takes 3 to 5 treatments to work. This is why I've stopped carrying Kybella in my office. I recommend neck liposuction more often then any injectable procedure for the neck now. It provides superior results gives me more control over the area than any injectable. It also costs about the same as what you paid for your first kybella session. The liposuction can be done under local while awake in the office and recovery is about the same as kybella.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jason Emer, MD · Answer

In our practice, we perform a non-surgical face lift / skin resurfacing treatment using Renuvion Helium Plasma Radiofrequency. ​To get the most improvement with skin tightening, we combine Renuvion (formerly J-Plasma) with lasers (Fraxel, Clear + Brilliant, CO2), microneedling/PRP, Ultherapy and InMode FaceTite. I suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer​​​​

Michael P. Morrissette, DDS, FACS · Answer

It appears that you may have a somewhat recessive chin and subcutaneous fat deposits beneath the chin and along the jawline. Treatment possibilities include submental and jawline liposuction,  chin implant, and midline platysmaplasty. A clinical exam is needed to give you the best advice.

Marc Polacco, MD · Answer

Thank you for your question. The best treatment depends on your goals and expectations, as well as consideration of risks and downtime. For the jawline and neck region, liposuction would work well given your anatomy. Kybella works as well, however it take multiple treatments and also does not address skin laxity. For fuller cheeks, there are also multiple options, including fillers, implants, or a facelift.

Anshul Gambhir, MD · Answer

Thank you for your question! I think you could definitely be treated with coolsculpting under your chin which can help to tighten any skin laxity as well. If you are still having fullness in your lower face after maximizing on coolsculpting then we could fine tune with kybella along the jawline if needed. I do think some chin filler (voluma) would help with the projection of your chin and also help to elongate the jawline and make it appear slimmer. Without seeing full face photos I cant determine if cheek or under eye filler would benefit you. Hope this helps!

William Portuese, MD · Answer

The Photographs demonstrate fat deposits located both above AND below the platysma muscle in your neck along with a recessive chin profile. Consider placement of a chin implant to augment your chin forward for better facial balance and proportions, which will also get better structural support for the soft tissues in the neck. A neck lift procedure can accomplish removal of both compartments of fat along with a platysma plasty to significantly improve the jawline. No skin removal is required. Liposuction alone will only remove the fat deposits above the platysma muscle and will be ineffective.

Darryl J. Blinski, MD · Answer

Without in person or virtual consult my recommendation is Y lift HA filler facelifting with the 1-stitch facelift suture, lipo under chin, filler chin enlargement. Fee $15,000.

Mats Hagstrom, MD (license on probation) · Answer

All of your listed concerns are related to the size and shape of your Mandevilla especially as it relates to your Maxilla.

Having a small, under developed mandible that lacks forward projection causes premature jowls, a double chin and lack of jawline definition.

If you want to address the primary problem then you need to consult with oral surgeons.

The imbalance can be seen on your profile and that your upper lip has more forward projection than your lower lip. This lip relationship is directly related to where your teeth are and most likely you have an overbite. The teeth are related to the Maxilla and the mandible.

When the mandible does not project than the origin of the platysma muscle drives the neck in the more oblique fashion causing these undesirable traits.

Augmenting the chin will give projection but doesn’t move the mandible forward. In other words placing a chin implant are using fillers will not correct the origin of the platesism muscle, the overbite, relationship between your upper and lower lips and so the primary problem remains with a simplistic solution for only augmenting the tip of the chin.

For some people the concerns are enough to warrant definitive surgery.

For others they are not.

Liposuction works well for jawline definition and reducing the double chin. The potential improvement is directly related to how much fat there is to take out.

Kybella  is in inferior technique for fat removal. It is in precise, unpredictable and causes an unnecessary amount of swelling compared to well done Liposuction.

Liposuction can be done as an office based procedure using local anesthesia and the recovery is usually pretty subtle and quick.

On top of this patient’s opting for Kybella after need to go through this massive inflammatory response which is way worse than Liposuction several times.

You’ll find providers who do not have the skills to deliver Liposuction recommending Kybella while very few plastic surgeons will recommend it as a first line option.

Coolsculpting is at the bottom of the list for high satisfaction fat removal.

You’re probably doing this already but daily sunscreen is the most effective long-term solution for preventing premature aging of the face.

It may be worthwhile to consult with oral surgeons or plastic surgeons with cranial facial surgery fellowship training who do more advanced mandible surgery on a regular basis.

At least after that you’ll have a clear understanding of treatment options and what’s involved.

Best,

Mats Hagstrom MD

Is non-surgical Facelift my best option? (photos)

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