41 & get fillers for my jowls and marionette lines. Would laser treatment help overall laxity? Not ready for full lift? (Photo)

Thank you for your question. You submitted a single photo, state you are 41-years-old, you are concerned about the marionette lines and jowls, the overall skin laxity, and are aware you have under eye bags. You state you are not quite ready for a facelift. You are concerned that injectable fillers can make the lower part of your face look wide. You’re asking can laser improve these areas, and I think you are looking to get some clarification on the strategy.I can share with you how I discuss these concerns with my patients every day, all day in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Customizing solutions using lasers, injectables, as well as surgical and other non-surgical options are what we spend all day doing to help our patients, and the questions you’re asking are reflective of the current state of options in the aesthetic field. Thanks to a lot of very aggressive marketing between manufacturers of devices and products, and the different interests of medical and non-medical providers, it creates a lot of confusion.
Just by looking at your photo, it is unlikely you are a good candidate for a facelift at this stage. Having done a lot of facelifts in my career and continuing to do so, the reason a lot of patients first consider a facelift is when they pull their skin upward doing what’s called the mirror lift, things look better. The reality is that unless the skin moves significantly, and what you are trying to do is improve the jawline and neck, through that action at this age, this is usually not the right time. That doesn't mean it’s not possible, as my youngest patient I ever did a facelift for was 37-years-old, but that was more of a limited facelift as opposed to a type of a facelift we do on someone typically in their 60s and older which is more of a face and neck lift.
It’s very important before defining the solutions to define the problem going to the core basis which is anatomy. What happens at 41 that’s different than what you were like when you were 31? There are two basic issues: volume loss in the bone level, and loss of fat at the soft tissue level. This is what implies there is laxity because when you pull, you feel like there’s loose skin - if the foundation has diminished, then the covering will get loose.
There is no shortage of lasers that can help with this overall situation. I understand your concerns about the use of fillers. Fillers traditionally are used in a way to chase lines. When you have a nasolabial fold or marionette lines that are deep, you can get fillers to soften those lines. Generally, the lines are more of a reflection of a global change, and more of symptom.
We offer a procedure in our practice called Structural Volumizing which is probably relevant to your situation. The concept of Structural Volumizing is the application of fillers at a deeper level, basically on the bone structure so the underlying bone, and the muscle overlying the bone work together in a way that creates restoration of some of that lost volume I described earlier - the loss of bone as well as fat.
What’s nice about this approach is the skin doesn't get weighed down by the volume of the filler. Often people don't like the results they see of people who had fillers because they can look rounded or can look widened. With Structural Volumizing, we can enhance and balance a lot of the angularities that could be missing. There is something called the Golden Ratio which in nature is seen as very attractive. When you compare and you see this in models, you look at the cheek structure relative to the jawline structure of a 1.6 to 1 ratio. This also applies to the profile so the jowl areas and the cheekbones can also be enhanced. When this material such as a long lasting hyaluronic acid filler like Juvederm Ultra Plus or Juvederm Voluma is placed at this level, the material can also last over one year, so there’s also a very nice benefit in not needing frequent reapplication.
Where does laser fall into this? As far as your under eye bags are concerned, laser will really not get rid of them. There are a lot of different types of lasers, and there are ways to help soften the under eye bags. Depending on the degree of the under eye bags, they represent something called lower eyelid fat prolapse. Depending on the degree of the prominence of the under eye bags, we can soften their appearance with an injectable filler such as Restylane or softer hyaluronic acid filler, or we do a procedure called transconjunctival lower eyelid blepharoplasty where the fat pockets are reduced so they don't bulge out. This requires more of a physical examination, but these are options I think would be more effective than laser.
Laser does fit help skin quality and texture. The spectrum of lasers we have can do a lot for pigmentation, vessels, skin quality, and limited in terms of skin tightening. Generally speaking, I find when you restore volume, tightening becomes less of a priority for the patient who initially asked to be tightened. I look at skin as more as the icing which we do after everything else is done. Too many people keep trying to use lasers or thermal energy devices as substitutes for surgical procedures or other procedures, but they can only do so much. You have to remember the skin is about 2 millimeters in thickness. There’s not a lot of room to work with, and you can only do so much.
In our practice, we have several types of lasers that provide solutions to everything from wrinkles, pigmentation, vessels, and a lot of other things including skin tightening, but we have to use them appropriately as tools.
Meet with qualified, experienced physicians who can review these issues with you. Make sure you spend a lot of time in analysis so you are able to get a sense of what strategy makes the most sense to you in terms your resources, your time, and expected outcome. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting, and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Great question - you certainly would be young for a facelift, and you would be then looking at repeating the procedure a few times in your life with potentially worse results. Laser can offer some skin tightening overall and particularly around your eyes, but frankly, judicious use of filler is probably the thing which will give you the best and most natural look. I'd go back to pictures of yourself in your early 20's and that will probably highlight the issues. Share those pictures with your injector and make sure you see a very experienced one with a reputation for giving a look similar to that which you are looking for.